The Correct Answer is A!

 

A 27-year-old white woman presents in the doctor’s office to discuss issues with colon cancer screening. She is asymptomatic. Her mother, who is 57 years of age, has been diagnosed with endometrial cancer and her mother’s oncologist suggests that she see a physician. Her mother was diagnosed with colon cancer at age 47. Her grandmother died of renal cancer at age 64. Her brother had surgery for small bowel cancer when he was 38 years of age.

Which would be the most appropriate management for this asymptomatic 27-year-old woman?

A. Colonoscopy now
B. Colonoscopy at age 37
C. Colonoscopy at age 45
D. Colonoscopy at age 50

Rationale:

Colonoscopy now is the correct answer because the patient is part of a hereditary colon cancer family diagnosed at young ages suggesting Lynch Syndrome. The occurrence of other cancers such as endometrial, renal, and small bowel cancer, and the occurrence across multiple generations also likely suggest Lynch syndrome. A colonoscopy is recommended every 1-2 years, starting at age 20 to 25 years, or 10 years before the first familial case, whichever is earlier. Colonoscopy at age 37, 45, and 50 are incorrect because the recommendation should be based on the above factors.

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