A 40-year-old man comes to the office for evaluation after his 52-year-old brother was diagnosed with colon cancer. Family history is otherwise negative for malignancy. The patient feels well and has experienced no abdominal pain, diarrhea, hematochezia, or unexpected weight loss. He has a sedentary lifestyle, and his diet includes a preponderance of processed foods and red meat with minimal fruits and vegetables. Medical history is unremarkable; he takes no medications. The patient has a 20-pack-year history and drinks 1 or 2 alcoholic beverages most days. Vital signs are normal. BMI is 28 kg/m². Physical examination shows no abnormalities. Which of the following is the most appropriate response to this patient regarding his risk for colon cancer?

Question

Quizplus · Accepted Answer

Explanation: 11ec2b69_bf29_a294_8f63_31dbfe77910e_MD0005_00 This patient has a first-degree relative with colorectal cancer (CRC). Patients who have a first-degree relative with sporadic CRC or high-risk adenomatous polyps (eg, ≥10 mm) have at least a 2-fold increase in risk for CRC (Choice E), particularly those whose relative was diagnosed at age <60 and those who have >1 first-degree relative with CRC. Those who have a family history of hereditary colon cancer syndromes (eg, Lynch syndrome) are likely at even greater risk. Patients who have a first-degree relative with CRC diagnosed at age <60 should undergo screening colonoscopy beginning at age 40 (or 10 years prior to the relative's age at diagnosis, whichever is earlier) and repeated every 5 years thereafter. This contrasts with screening in average-risk individuals, which is recommended beginning at age 45. (Choice A) Asymptomatic CRC is common, especially with right-sided lesions. Lack of symptoms should not deter appropriate screening. (Choice C) Daily low-dose aspirin is associated with a small decrease in CRC risk, but the benefit is largely offset by increased upper gastrointestinal bleeding risk. The decision to initiate low-dose aspirin is largely determined by its cardiovascular benefit. Patients age 50-69 with a 10-year cardiovascular disease risk of ≥10% can be considered for daily aspirin for both CRC and cardiovascular disease prevention, but daily aspirin is not generally recommended based on a patient's CRC risk alone or for those age <50. (Choice D) Other risk factors for CRC include obesity, a diet high in red and processed meat, tobacco use, and heavy alcohol use. However, these risk factors are much weaker than family history, and there is insufficient evidence to support more aggressive screening recommendations. Educational objective: Patients who have a first-degree relative with colorectal cancer (CRC) diagnosed at age <60 are themselves at increased risk for CRC. These patients should undergo screening colonoscopy beginning at age 40 (or 10 years prior to the relative's age at diagnosis, whichever is earlier) and repeated every 5 years thereafter.

A 40-Year-Old Man Comes to the Office for Evaluation After