AB024. SOH22ABS189. Patients with a family history of colorectal cancer (CRC) within a surveillance programme, a case series review to evaluate the compliance of colonoscopy and frequency of genetics referrals

Background: The guidelines on the management of familial cancer were updated in 2020 and have led to more stringent use of surveillance colonoscopies. Patients within a surveillance programme at two large district hospitals were studied to assess the impact of these new guidelines.

Methods: All patients on colonoscopic surveillance at our trust who had familial cancer risks, underwent a rigorous questionnaire and case-note review. Patients were categorised into those with low (not needing surveillance or a one-off scope at age 50) or high risk (needing 5 yearly or more intense surveillance). Concordance between observed surveillance frequency and expected risk after questionnaire assessment was studied. Chi-square test was used, a P value of 0.05 was deemed significant.

Results: There were 435 (220 female) patients. Median age was 57 (IQR 49–64) years. Overall concordance between surveillance intensity and actual family history risk was poor at 27% with tendencies towards excessive surveillance in 60% of patients. Inadequate surveillance was rare at 3%. After questionnaire validation a greater proportion of patients could be removed from high intensity surveillance. Two hundred and forty-one (55.3%) patients had been referred to clinical geneticist. Patients at high-risk were more likely to be referred when compared with those at low risk (84% vs. 36%, P=0.001). However, 92/241 (38%) patients may have been referred unnecessarily due to inappropriate risk assessment or inadequate information at time of consultation.

Conclusions: Questionnaire validation allow appropriate risk stratification and a reduction of unnecessary colonoscopies in patients with low to moderate risk of familial cancer.

Keywords: Colorectal cancer (CRC); family history; cancer surveillance; colonoscopy; genetic referrals