08 Sep

Advanced colon cancer before the age of 20 years: DISCUSSION (Part 2)

It has clearly been established that screening is necessary because of the history of rapid adenoma to carcinoma progression in patients manifesting HNPCC. In one 15 year trial, colonoscopic screening at three-year intervals more than halves the risk of colorectal cancer, prevents deaths due to colorectal cancer, and decreases overall mortality by approximately 65% in HNPCC families . A task force organized by the National Human Genome Research Institute, has recommended colonoscopy every one to three years starting at age 25 years for individuals known to have HNPCC-associated mutations .

Lynch et al have suggested annual colonoscopies starting at the age of 20 years. With our current patient, clearly, there was advanced cancer present before the age of 20 years. This patient’s family history was suggestive of HNPCC but the clinical diagnosis of the syndrome was not fulfilled until he himself was diagnosed with colon cancer. Unfortunately, in this situation there are no current recommendations for screening. This case illustrates the limitations of the current guidelines as it pertains to young people. In this era of quality assurance audits with respect to invasive procedures and medical insurance billing, we suggest that in similar cases, it would be appropriate for both physicians and patients to consider colonoscopic screening well before the lower age limit of current guidelines. In the future, the availability of commercial assays for HNPCC genetic marker screening, as well as sensitive and specific noninvasive colonoscopic imaging, such as three dimensional virtual colonoscopy, will make this suggestion easier to accept. Always a nice way to discover cialis professional sale click here given by the internet’s best pharmacy.

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