{'fraction_non_alphanumeric': 0.020460358056265986, 'fraction_numerical': 0.05224698575082207, 'mean_word_length': 5.070953436807096, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 2, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Family History of Colorectal Adenomas: Taking the Methodological Bull by the Horns.

75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 Adegree relative increases one’s average lifetime risk of CRC. The magnitude of the risk increase is affected by the age of the individual, age of the affected relative, number of affected relatives, and degree of familial relation. Guidelines currently recommend early initiation of screening colonoscopy (at age 40 or 10 years before the age of CRC diagnosis in the youngest affected relative), and surveillance intervals which depend on the age and number of affected first-degree relatives. Conversely, there is less clarity when the affected relative has precancerous adenomatous polyps, with some guidelines recommending screening strategies similar to those for persons with a firstdegree relative with CRC, and others making no specific recommendations. One of the reasons for these discrepancies is that the literature addressing colorectal neoplasia in first-degree relatives of patients with adenomatous polyps has limitations that have hampered efforts to draw more robust, evidence-based recommendations. Some of the limitations pertaining to CRC-related risks were recently highlighted in a systematic review by Imperiale and Ransohoff, which reported that 10 of 12 relevant studies actually assessed the risk of adenomas in persons with a first-degree relative with CRC, rather than CRC risk in persons with a first-degree relative with adenoma. The 2 remaining studies were better designed to address the latter question, although both had limitations. The first study was conducted in Japan; 6139 patients underwent screening colonoscopy after completing a questionnaire that inquired about family history of CRC or adenomas. The relative risk of CRC among persons reporting first-degree relatives with adenomas compared with those reporting no family history of CRC or adenomas was 4.36 (95% CI, 1.60-10.21). One limitation of this study was the reliance on survey data for information on polyp histology without medical record verification. Patients rarely accurately recall the type of polyps they themselves had; thus, unverified reports about polyp histology in relatives are likely even more prone to misclassification. The second study was conducted in France; investigators identified 306 patients with large ( 1 cm) adenomas and enrolled 168 of their first-degree relatives (from 674 who were contacted) who either agreed to undergo colonoscopy or had undergone colonoscopy in the preceding 5 years. These 168 individuals were matched (for age, sex, and geographic location) with