Family History Of Colon Cancer And Ulcerative Colitis

Timothy C. Hoops, MD
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
My mother suffered from ulcerative colitis from age 33-42. She finally had a j-pouch surgery in September.00 and is doing well. On her side, her brother and sister also both have ulcerative colitis... both diagnosed in their 30's. On my father's side, his father died of colon cancer at age 70, his sister has ulcerative colitis, and he has had polyps removed from his colon. His other sister also has IBS (which I understand is not related?). Please tell me what I can do to protect myself and prevent colon problems. I am already trying to increase my fiber intake, but it is very difficult for me to get 25g a day.
Thanks.

Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds:

First of all, while we know that a family history of colon cancer and having ulcerative colitis can each increase a person's risk for colon cancer (and together there may be an additive effect), your risk as an unaffected family member is harder to determine. Your father's history of polyps and your grandfather's colon cancer may raise your lifetime risk, but probably about two-fold at most. Ulcerative colitis can have a genetic component to it and you may be at risk for developing it, but there is no way to determine that beforehand with any certainty.

From a preventative standpoint, there is little that can be done for the ulcerative colitis that I am aware of. For colon cancer, there is no strong evidence that fiber decreases the risk, although there are other beneficial effects of fiber that might warrant its use. Other factors that have been shown to reduce colon cancer risk include calcium, folate (400 mg/day) and exercise. Hormone replacement therapy in postmenopausal women may also be beneficial. The most important thing to do is undergo colon cancer screening. Unless you have symptoms, you can probably wait until you turn 50. At a minimum, this should be annual stool occult blood testing (Hemoccult) and a flexible sigmoidoscopy every 5 years, or a colonoscopy every 10 years. This is the best colon cancer risk reduction method available.