Digital Family History Assessment Improves CRC Risk Stratification in Endoscopy | Endoscopy

Introduction

Family history remains a critical but underused tool in colorectal cancer (CRC) risk assessment. Despite its importance in identifying individuals at increased hereditary risk, family history is often incompletely captured in routine endoscopy practice, leading to missed opportunities for genetic referral, inappropriate surveillance and inefficient colonoscopy use.

Problem Statement

Conventional family history assessment in endoscopy services is inconsistent, time-intensive and frequently insufficient for accurate CRC risk stratification. This creates two major clinical problems: overuse of colonoscopic surveillance in low-risk individuals and under-recognition of patients who may warrant enhanced surveillance or genetic evaluation. A practical, scalable approach is needed to integrate standardized hereditary risk assessment into routine endoscopy workflows.

Summary

This service improvement project demonstrates that integrating a digital family history questionnaire with a dedicated endoscopy genetic counsellor can substantially improve CRC risk stratification and surveillance efficiency within a modern endoscopy unit. In patients already undergoing family history–based surveillance, standardized reassessment led to clinically meaningful changes in surveillance recommendations for most patients, predominantly by downgrading unnecessary colonoscopy intensity, resulting in major reductions in avoidable procedures and substantial cost savings. In symptomatic patients, the same digital pathway identified previously unrecognized familial CRC risk, including individuals warranting moderate- or high-risk surveillance and potential genetic evaluation. These findings show that embedding structured family history assessment into routine endoscopy is both feasible and clinically impactful, improving risk stratification while optimizing resource utilization. The model is particularly valuable because it simultaneously reduces over-surveillance in low-risk patients and improves detection of individuals with clinically relevant inherited CRC risk. This scalable approach offers a practical framework for integrating precision prevention and genetic triage into everyday endoscopy practice.