Identifying the obstacles to colonoscopic screening of first-degree relatives with a family history of colorectal cancer. Where do GPs stand?

Clara Blanchard, Nicolas Palierne, Isabelle Ingrand

Keywords: colorectal cancer; screening; general practice; compliance

Colonoscopic screening allows early detection of colorectal cancer and adenomatous polyps. Screening family members around an index case is essential to reduce morbidity and mortality of this cancer which is the third most common cause of cancer mortality worldwide. General practitioners have an important role to play in this strategy.

Research questions:
What are the obstacles to implementing colonoscopic screening in first-degree family members? What do GPs feel is their role in this screening strategy? What could help GPs inform their patients of their high risk and the importance of screening?

As part of the COLOR3 research program in Poitou-Charente, France, GPs of first-degree relatives were sent a leaflet informing them of their patients family history and the importance of discussing colonoscopic screening with them. The GPs were then contacted by an sociologist who anonymously evaluated their knowledge of the screening strategy, their motivation to implement it, their capability of doing so and their appreciation of their role.

Few GPs expressed ease at implementing colonoscopic screening for first-degree relatives. They described a lack of communication between relatives, between specialists and the referent GP and a lack of time to update family history at each visit, as being the main brakes to discuss this screening with patients. Some also argued that it was not their place to convince patients to participate in screening strategies.

Referent GPs are not well equipped to discuss familial screening for CRC around an index case. This study shows that information does not flow well from the initial diagnosis down to the relatives and their care-givers. This study also shows that sending an information leaflet alone is not sufficient to help the referent GP.

Points for discussion:
How important is the taboo around CRC? Making it harder to discuss than other screening programs.

What role should GPs have in the screening strategy?