A 37-year-old man comes to the office for a routine preventive visit. He is healthy and asymptomatic and has no significant medical history. The patient has a 5-pack-year smoking history but quit 10 years ago. He drinks 1 or 2 beers daily. The patient works as a sales manager for a manufacturing company. His father had colon cancer that was diagnosed at age 53, but there is no other family history of cancer. Vital signs are within normal limits. No abnormalities are noted on examination. Which of the following is the most appropriate next step in management of this patient?

Question

A 37-year-old man comes to the office for a routine preventive visit.  He is healthy and asymptomatic and has no significant medical history.  The patient has a 5-pack-year smoking history but quit 10 years ago.  He drinks 1 or 2 beers daily.  The patient works as a sales manager for a manufacturing company.  His father had colon cancer that was diagnosed at age 53, but there is no other family history of cancer.  Vital signs are within normal limits.  No abnormalities are noted on examination.  Which of the following is the most appropriate next step in management of this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c151_8c45_8f63_716380bb0090_MD0005_00 Colon cancer screening is recommended beginning at age 45 for individuals at average risk. However, those who have a first-degree relative with colon cancer are at increased risk and therefore warrant screening beginning at an earlier age (Choice A). Patients who have a first-degree relative with sporadic (ie, not related to a hereditary colon cancer syndrome) colon cancer or advanced adenoma (eg, ≥10 mm, high-grade dysplasia) should be offered screening beginning at age 40 or 10 years before the age at which the relative's colon cancer was diagnosed, whichever comes first (Choices C and D). This patient, whose father was diagnosed with colon cancer at age 53, should be offered colonoscopy at age 40. If the patient's initial colonoscopy is normal, repeat colonoscopy should be offered every 5 years (routine 10-year intervals can be considered for those who have only 1 first-degree relative with colon cancer if the diagnosis was made after age 60). (Choice E) Genetic testing for hereditary colon cancer syndromes (eg, familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer [Lynch syndrome]) is usually recommended for patients with a stronger family history (eg, multiple relatives with cancer at a young age or at multiple sites). Having 1 relative with sporadic colon cancer does not warrant genetic testing. Educational objective: Patients at average risk for colon cancer should start colon cancer screening at age 45. For those with a first-degree relative with colon cancer or advanced adenoma, screening colonoscopy is recommended beginning at age 40 or 10 years before the relative's age at diagnosis, whichever comes first. References: Screening for colorectal cancer: US Preventive Services Task Force recommendation statement (http://www.ncbi.nlm.nih.gov/pubmed/34003218)

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