A 37-year-old man comes to the office for a routine health maintenance examination. He has been feeling well and has no significant symptoms. The patient does not use tobacco, alcohol, or illicit drugs. His father was diagnosed with rectal cancer at age 50 and underwent partial colectomy. Vital signs and physical examination show no abnormalities. Which of the following is the most appropriate initial screening test for this patient?

Question

A 37-year-old man comes to the office for a routine health maintenance examination.  He has been feeling well and has no significant symptoms.  The patient does not use tobacco, alcohol, or illicit drugs.  His father was diagnosed with rectal cancer at age 50 and underwent partial colectomy.  Vital signs and physical examination show no abnormalities.  Which of the following is the most appropriate initial screening test for this patient?

Quizplus · Accepted Answer

11ec25c8_d220_9402_bc81_e1368966462c_MD0003_00 For average-risk adults, screening for colorectal cancer (CRC) is recommended beginning at age 45. Commonly used modalities include annual fecal occult blood testing, multitarget stool DNA testing every 1-3 years, and colonoscopy every 10 years. However, patients with a first-degree family history of CRC (as in this case) or advanced adenomatous polyps (eg, ≥10 mm, high-grade dysplasia, villous elements) are at increased risk and should undergo earlier testing. Of the available screening methods, colonoscopy has the greatest sensitivity and is the recommended option for individuals at increased risk. Patients with a first-degree family history of CRC should undergo initial colonoscopy at age 40 or 10 years prior to the age of diagnosis of that relative, whichever is earlier (Choices B, C, and D). greatest sensitivity If the relative's CRC was diagnosed at an early age (ie, <60), the patient's screening colonoscopy should be repeated every 5 years. If the relative's CRC was diagnosed at a later age (ie, ≥60) and the patient has a normal initial colonoscopy, the patient has only a nominally increased risk for CRC and may undergo repeat screening as for an average-risk patient. (Choices E and F) Yearly fecal occult blood testing is not recommended for individuals at increased risk of CRC because it has low sensitivity compared to colonoscopy; visualization of the entire colon with colonoscopy is preferred. If the individual is not willing to undergo colonoscopy, yearly multitarget stool DNA test is reasonable given its high sensitivity. Educational objective: For average-risk adults, screening for colorectal cancer (CRC) is recommended beginning at age 45. Patients with a first-degree family history of CRC or advanced adenomatous polyps are at increased risk and should undergo screening colonoscopy beginning at age 40 or 10 years prior to the age of diagnosis of the first-degree relative, whichever comes first. References: Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. (http://www.ncbi.nlm.nih.gov/pubmed/34003218) ACG clinical guidelines: colorectal cancer screening 2021. (http://www.ncbi.nlm.nih.gov/pubmed/33657038)

A 37-Year-Old Man Comes to the Office for a Routine