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Scientists have analyzed the data of more than 12 million people to find out at what age people who have one or more close or distant relatives with colorectal cancer in their family should start going to screening. The researchers from the German Cancer Research Center (DKFZ) and the National Center for Tumor Diseases (NCT) in Heidelberg were able to show at what age familial predisposed persons should start colorectal cancer screening, depending on the number of colorectal cancer patients in the family, the family relationship, and the age at diagnosis. As a rule, women and men can start screening from the age of 50. Special recommendations apply for families with hereditary colorectal cancer.

National Center for Tumor Diseases (NCT) Heidelberg, a joint institution of the German Cancer Research Center (DKFZ), the University Hospital Heidelberg (UKHD) and the German Cancer Aid (DKH).

Colorectal cancer is the third most common cancer and the second main cause of cancer death all over the world. In addition to environmental factors, important risk factors also lie in our lifestyle: overweight and lack of exercise, alcohol and tobacco consumption, consumption of red or processed meat. In addition, a number of unchanging factors such as age, gender and family history also play a role. Hereditary forms are also known. If colorectal cancer is detected at an early stage, the chances of recovery are good. From age 50 years, every insured person in Germany is entitled to regular examinations for the early detection of colorectal cancer.

"Although existing guidelines of colorectal cancer take recognize the need for earlier screening for people with close and distant relatives of patients with colorectal cancer, there is so far little evidence-based information on how many years earlier these high-risk individuals should undergo the screening," said Mahdi Fallah, leader of the Risk Adapted Prevention Group, in the Division of Preventive Oncology at the DKFZ and the NCT Heidelberg.

In cooperation with colleagues from the University of Lund, the Heidelberg researchers have analyzed the data of 12,829,251 Swedish citizens born after 1931 and their parents. "Our goal was to provide risk-adapted and personalized recommendations for the starting age of colorectal cancer screening with different family histories by analyzing the world's largest family-cancer datasets," explains Elham Kharazmi, co-leader of the study and scientist at the DKFZ and the NCT Heidelberg.

During the study period from 1958 to 2015, 173,796 people developed colorectal cancer. The average population at age 50, which is the current recommended starting age for screening, had 0.44 percent risk of developing colorectal cancer in the next 10 years. According to the scientists' calculations, people with family history had the same risk of colorectal cancer 3 to 29 years earlier than their peers in the general population without such a family history. For example, individuals with an affected first-degree relative diagnosed before age 45 reached the corresponding risk level for colorectal cancer 16 years earlier.

The results of the study provide useful and practical information on cancer screening for the consultation of relatives of colorectal cancer patients. The findings can additionally support physicians in their practical work in assessing the starting age for colorectal cancer screening in a risk-tailored manner. In addition, the authors recommend that the findings should be included in the guidelines for colorectal cancer screening and that health insurance benefits for earlier screening should be accordingly adjusted for relatives of patients with colorectal cancer.

Original publication
Y. Tian, E. Kharazmi, H. Brenner, X. Xu, K. Sundquist, J. Sundquist, M. Fallah: Calculating Starting Age for Screening in Relatives of Patients With Colorectal Cancer Based on Data From Large Nationwide Datasets. Gastroenterology 2020; https://doi.org/10.1053/j.gastro.2020.03.063

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National Center for Tumor Diseases Heidelberg (NCT)
The National Center for Tumor Diseases (NCT) Heidelberg is a joint institution of the German Cancer Research Center, Heidelberg University Hospital (UKHD) and German Cancer Aid. The NCT's goal is to link promising approaches from cancer research with patient care from diagnosis to treatment, aftercare and prevention. This is true for diagnosis and treatment, follow-up care or prevention. The interdisciplinary tumor outpatient clinic is the central element of the NCT. Here, the patients benefit from an individual treatment plan prepared in interdisciplinary expert rounds, so-called tumor boards. Participation in clinical studies provides access to innovative therapies. The NCT thereby acts as a pioneering platform that translates novel research results from the laboratory into clinical practice. The NCT cooperates with self-help groups and supports them in their work. Since 2015, the NCT Heidelberg has maintained a partner site in Dresden. The Hopp Children's Cancer Center (KiTZ) was established in Heidelberg in 2017. The pediatric oncologists at KiTZ work together in parallel structures with the NCT Heidelberg.

German Cancer Research Center (DKFZ)
The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) with its more than 3,000 employees is the largest biomedical research institution in Germany. More than 1,300 scientists at the DKFZ investigate how cancer develops, identify cancer risk factors and search for new strategies to prevent people from developing cancer. They are developing new methods to diagnose tumors more precisely and treat cancer patients more successfully. The DKFZ's Cancer Information Service (KID) provides patients, interested citizens and experts with individual answers to all questions on cancer.
Jointly with partners from the university hospitals, the DKFZ operates the National Center for Tumor Diseases (NCT) in Heidelberg and Dresden, and the Hopp Children's Tumour Center KiTZ in Heidelberg. In the German Consortium for Translational Cancer Research (DKTK), one of the six German Centers for Health Research, the DKFZ maintains translational centers at seven university partner locations. NCT and DKTK sites combine excellent universtity medicine with the high-profile research of the DKFZ. They contribute to the endeavor of transferring promising approaches from cancer research to the clinic and thus improving the chances of cancer patients.
The DKFZ is 90 percent financed by the Federal Ministry of Education and Research and 10 percent by the state of Baden-Württemberg. The DKFZ is a member of the Helmholtz Association of German Research Centers.

Heidelberg University Hospital (UKHD)
Heidelberg University Hospital (UKHD) is one of the most important medical centers in Germany; Heidelberg University's Medical Faculty is one of Europe's most prestigious biomedical research facilities. Their shared objective is the development of innovative diagnostics and treatments and their prompt implementation for the benefit of the patient. The hospital and faculty employ approximately 13,000 individuals and are involved in training and qualification. Every year approximately 65,000 patients are treated as inpatients and 56,000 as day patients in more than 50 specialized clinical departments with around 2,000 beds, with more than 1 million patients being treated as outpatients. Together with the German Cancer Research Center and German Cancer Aid, the Heidelberg University Hospital established The National Center for Tumor Diseases (NCT) Heidelberg as the leading oncology center of excellence in Germany. The Heidelberg Curriculum Medicinale (HeiCuMed) is at the forefront of medical training in Germany. At present 3,700 aspiring physicians and doctors are studying in Heidelberg.