​BMJ: Family members have a history of intestinal polyps, and the risk of colorectal cancer is 16 times higher!

*It is only for medical professionals to read and refer to.
Take your family to check it out! Colorectal cancer is one of the most common and deadly malignant tumors of the digestive system.
It is estimated that by 2030, the global burden of colorectal cancer will increase by 60%, reaching more than 2.
2 million new cases of colorectal cancer and 1.
1 million deaths from colorectal cancer.
Cases.

 Although early colorectal cancer has a good prognosis, most colorectal cancers are already in the middle and advanced stages when they are discovered, and the prognosis is poor.
Among them, the 5-year survival rate for stage IV colorectal cancer is only 14%.

Therefore, prevention and screening are very necessary (there is a screening program at the end of the article).

Relatives have intestinal polyps, and the risk of colorectal cancer is significantly increased! Recently, the top international medical journal BMJ published a large retrospective clinical study from Sweden, which included a total of 401,813 cases nationwide in Sweden, on the history of intestinal polyps and/or colorectal cancer of the first-degree relatives of these groups After a systematic analysis, it was found that after adjusting for related interference factors, even if there is no family history of colorectal cancer, people with a family history of colorectal polyps are more likely to develop colorectal cancer! Figure 1 Screenshot of the literature.
16 colorectal cancer patients were obtained from the National Swedish Histopathology Report Enhanced Epidemiology (EXPRESSO) cohort, including information on gastrointestinal biopsy samples from 28 pathology departments in Sweden from 1965 to 2017.

In the EXPRESSO cohort, the histopathological features are defined by the morphology code (SNOMED) and the topographic map code.

To identify patients with colorectal cancer, the researchers used topographic map codes T67x (colon) and T68x (rectal) and SNOMED codes.

For each EXPRESSO cohort, the researchers selected five control groups from the general population matched by biopsy age (in years), gender, year of birth, and county of residence.

Among the 401,813 cases included in the study, 68,060 were colorectal cancer cases and 333,753 were in the control group.

From the family relationship data registered in multiple generations in Sweden, the researchers retrieved information about the family history and identified the first-degree relatives (parents and siblings) of the study participants, and assessed the first-degree relatives through contact with the EXPRESSO cohort History of colorectal polyps, and assessed the minimum age of polyp diagnosis and histological subtypes of polyps in first-degree relatives.
Advanced polyps include tubular or villous adenomas and sessile serrated polyps.

The researchers also assessed the colorectal cancer history of first-degree relatives based on the cancer register, which has been recording malignant tumors in Sweden since 1958, with an estimated completeness of 96.
3%.

 What pathological types of polyps do relatives suffer from, should family members be vigilant? First, the study found that the history of colorectal polyps in first-degree relatives increased the risk of colorectal cancer by 62%, and it still increased by 40% after adjusting for interfering factors.

And the pathological type of polyps is a key influencing factor: the risk of bowel cancer among first-degree relatives with hyperplastic polyps increases by 23%; sessile serration increases the risk of polyps by 27%; tubular adenoma increases the risk by 39%; villous glands Tumors increase the risk by 40%; among them, tubular villous adenoma has the highest risk, which has increased by 44%.

 Figure 2 The pathological types of polyps in first-degree relatives are related to the incidence of colorectal cancer.
The more polyps among relatives, the higher the risk of colorectal cancer! The study also showed that only one first-degree relative suffers from colorectal polyps, and the risk is 1.
38 times that of the general population; if there are two or more first-degree relatives with intestinal polyps, the risk will increase to 1.
70 times.

 In addition, the age of relatives when they have polyps will also affect the risk of colorectal cancer: intestinal polyps diagnosed when relatives are less than 50 years old, the risk is 1.
77 times that of ordinary people; and when the age is more than 70 years old, the risk of developing colorectal cancer It dropped to 1.
29 times.

 On the premise that there is only one first-degree relative with intestinal polyps, if the relative's diagnosis age is over 60 years old, the risk of colorectal cancer is 1.
33 times that of ordinary people; if the relative's diagnosis age is less than 60 years old, the risk is 1.
51 times .

When there are 2 or more first-degree relatives with intestinal polyps, the youngest relatives are younger than 60 years old, the risk rises to the highest, up to 1.
82 times.  Figure 3 The number of patients with polyps in first-degree relatives and the age of disease and the incidence of colorectal cancer.
Intestinal polyps and family history of colorectal cancer are more likely to develop early-onset colorectal cancer.
This study jointly analyzed the family history of intestinal polyps and family history of colorectal cancer Impact on the risk of colorectal cancer.

When there are 2 or more first-degree relatives with intestinal polyps, but there is no family history of intestinal cancer, the risk of intestinal cancer is increased to 1.
79 times; when there is 1 first-degree relative with intestinal cancer, but there is no family history of intestinal polyps , The risk of disease is 1.
70 times, and there is no significant difference between the two.

But when two or more first-degree relatives have a history of bowel polyps and bowel cancer at the same time, the risk of disease can reach 5.
00 times! The risk of early-onset colorectal cancer is 16.
57 times that of the general population! According to the results of this study, even if there is no family history of bowel cancer, patients with bowel polyps in first-degree relatives should be paid attention to, and screening should be carried out as soon as possible to reduce the risk of early-onset colorectal cancer.

How to screen for colorectal cancer? Seeing this, you can’t wait to know how to screen for colorectal cancer! The editor recommends this screening: ■ Colorectal cancer screening method: colonoscopy, although the inspection process is not comfortable, colonoscopy is still the gold standard for screening and diagnosing bowel cancer, which can detect precancerous lesions and remove them , Thereby reducing the incidence and mortality of colorectal cancer.

Frequency: People over the age of 40 receive a fecal occult blood test (FOBT) check once a year; familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC) family members over the age of 20 are checked every time the gene mutation is clear Colonoscopy is performed once in 1-2 years.
Asymptomatic screening subjects aged 45-75 have FOBT examinations once a year, and colonoscopy once every 10 years.

If you find this article useful, please like it and watch it! References: 1.
Song MY, et al.
Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden.
BMJ.
2021 May 4;373:n877.
doi: 10.
1136/bmj.
n877 .