Who are at risk from familial colorectal cancer and how can they be managed?

How to ide~r~tifl' individual!; and families at risk. for colii)rec:tal can•cer1' Asking a simple question, 'has anyone had cancer in your family?', can quite easily identify these families. An affirmative answer leads to the follow-up questions, 'Who has had cancer-parents, siblings or children (first-degree relatives); grandparents, grandcl1ildren, uncles, aunts (seconddegree r•9latives); cousins?; Wt1ere did these tu rnors occur-colon, breast, ovary, etc?, and 'At what agH did these occur?'. If asking these simple questions becomes routine, t11en they are not time-consuming and can identify individuals and families at risk for common malignancies (Table 6.1). Answers that cause the p1ysician to suspect a familial risk factor include cancers occurring t1efore the age of 50-5~i years, several cancers occurring in the sam•9 individual and/ or cancers occurring in two or more first or second-degree relatives. These 'alarm' answers demand a more detailed cancer pedigree (Figure 6.2a).