Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.
Colorectal Dis. 2018 Oct;20(10):897-904. doi: 10.1111/codi.14319. Epub 2018 Jul 16.
Most people who are at increased familial colorectal cancer (FCRC) risk are not identified, despite the need for enhanced surveillance colonoscopy for effective CRC prevention. An online self-test may enhance this identification. We assessed whether taking an online self-test to identify increased FCRC risk increases anxiety, distress or CRC risk perception in population-based CRC screening.
After the precolonoscopy consultation, patients who had a positive immunohistochemical occult faecal blood test (iFOBT+) in population-based CRC screening were invited by email to take an online self-test at home which returned details of family history. Anxiety (STAI-DY), distress (HADS) and CRC risk perception were assessed immediately before and after taking the online self-test and 2 weeks later.
Of 250 participants invited, 177 (71%) completed the online self-test and psychological questionnaires and 153 (61%) completed questionnaires 2 weeks later. The median age was 65 years (range 61-75). The FCRC risk was increased in 17 participants (9.6%). Of these, 12 (6.8%) had a highly increased FCRC risk and may benefit from germline genetic testing for Lynch syndrome. In 7 of 17 participants (40%) the self-test obtained novel information on family history. Anxiety and distress levels were, and remained, below a clinically relevant level. Perception of CRC risk remained unchanged. Most participants (83%) would recommend the online self-test to others.
Of those with a iFOBT+, 9.6% had a previously unidentified increasedFCRC risk and require an enhanced surveillance colonoscopy instead of iFOBT. As screening for this risk did not increase anxiety or distress, and was highly acceptable, we recommend adding the online self-test to population-based CRC screening.
尽管需要进行增强型结肠镜检查以有效预防结直肠癌（CRC），但仍有许多具有结直肠家族性癌症（FCRC）高危风险的人未被识别。在线自测可能有助于识别这些风险。我们评估了在基于人群的 CRC 筛查中，进行在线自测以识别增加的 FCRC 风险是否会增加焦虑、困扰或对 CRC 风险的感知。
在结肠镜检查前的咨询后，通过电子邮件邀请在基于人群的 CRC 筛查中免疫组化法粪便隐血试验（iFOBT+）阳性的患者在家中进行在线自测，该自测将详细了解家族史。在进行在线自测前后以及 2 周后，立即评估焦虑（STAI-DY）、困扰（HADS）和 CRC 风险感知。
在 250 名受邀参与者中，177 名（71%）完成了在线自测和心理问卷，153 名（61%）在 2 周后完成了问卷。中位年龄为 65 岁（范围为 61-75 岁）。17 名参与者（9.6%）的 FCRC 风险增加。其中 12 名（6.8%）具有高度增加的 FCRC 风险，可能受益于林奇综合征的种系基因检测。在 17 名参与者中的 7 名（40%）中，自测获得了家族史的新信息。焦虑和困扰水平仍然处于临床相关水平以下。对 CRC 风险的感知保持不变。大多数参与者（83%）会向他人推荐在线自测。
在 iFOBT+的人群中，9.6%的人具有先前未识别的增加的 FCRC 风险，需要进行增强型结肠镜检查，而不是 iFOBT。由于筛查这种风险并未增加焦虑或困扰，并且非常被接受，因此我们建议在基于人群的 CRC 筛查中增加在线自测。
