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Colorectal Cancer: Is Your Patient at High Risk?
Developed by the AMA and the National Coalition for Health Professional Education in Genetics (NCHPEG), the goal of this program is to improve the primary care provider's ability to identify, evaluate, and manage patients at increased risk of hereditary colorectal cancer (CRC). This program was funded in part by unrestricted educational grants from Myriad Genetics and Humana, and by the Veterans Health Administration contract #VA200P0034.

This program is divided into four modules: Assessing Risk, Genetic Testing, Risk Communication and Counseling, and Screening and Surveillance. Each module entails a series of patient scenarios that focus on the goals of that particular lesson. Participants will have access to point of care tools that will help in completing the activities and questions in the patient scenarios, and can also be downloaded and printed for use in practice. The program covers the most common hereditary CRC syndromes: Lynch syndrome and Familial Adenomatous Polyposis (FAP) and Attenuated FAP. Working through short case studies, participants will practice identifying, evaluating, and managing patients with hereditary CRC syndromes. The program also provides strategies for counseling patients before and after genetic testing, approaches to communicating risk, and tools to help in collaboration with a genetic or other specialist.

Should you have any questions regarding this activity please contact Katie Johansen Taber at katherine.johansen@ama-assn.org or 312-464-4964.

Colorectal Cancer: Is Your Patient at High Risk?

Colorectal Cancer: Is Your Patient at High Risk?
Release Date: June 29, 2012
Expiration Date: June 28, 2015

Objectives

At the end of this activity, physicians should be able to:

  1. Collect a family history targeted to cancer.
  2. Identify red flags that indicate the presence of a hereditary colorectal cancer syndrome.
  3. Develop an appropriate genetic testing strategy for diagnosis of a suspected hereditary colorectal cancer syndrome.
  4. Identity collaborators for providing pre-and post-test risk communication and counseling to patients.
  5. Identify surveillance and management strategies for patients with, or at risk for developing, colorectal cancer.

Target Audience
This activity is designed to meet the educational needs of all primary care physicians, but is also appropriate for other specialists such as gastroenterologists and surgeons. Other non-physician health care providers, such as genetic counselors and nurses, may find the activity beneficial.

Statement of Need
Guidelines developed by the National Comprehensive Cancer Network and the American College of Gastroenterology have outlined risk assessment, genetic testing, and management strategies. There is a demonstrated need for physicians to become more knowledgeable about hereditary CRC and the established guidelines for managing patients at risk.

Statement of Competency
This activity is designed to address the following ABMS/ACGME competencies: patient care, medical knowledge, and interpersonal and communication skills.

Accreditation Statement
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
The American Medical Association designates this enduring material for a maximum of 6.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Planning Committee

•  Emily Edelman, MS, CGC – Project Director/NCHPEG
•  Katherine Johansen Taber, PhD – Senior Scientist/AMA
•  Therese Ingram Nissen, MA – Instructional Designer/NCHPEG
•  Kate Reed, MPH, ScM, CGC – Project Director/NCHPEG
•  Jessica Sempek, MS – CME Program Committee/AMA

Faculty

•  Abdallah Elias, MD – Family Practitioner and Clinical Genetics Fellow, Johns Hopkins Hospital, Content Reviewer
•  Emily Edelman, MS, CGC – Project Director, NCHPEG, Author
•  Katherine Johansen Taber, PhD – Senior Scientist, AMA, Author
•  Sonia Kupfer, MD – Instructor of Medicine, Gastroenterologist, University of Chicago, Content Consultant
•  Kate Murphy – Project Director of Research Communication, Colorectal Cancer Coalition, Content Consultant
•  Therese Ingram Nissen, MA – Instructional Designer, NCHPEG, Author
•  Kate Reed, MPH, ScM, CGC – Project Director, Author
•  Jessica Sempek, MS – CME Program Committee, AMA
•  David Swee, MD – Associate Dean for Education, RWJ Medical School, University of Medicine and Dentistry of New Jersey, Content Consultant
•  Scott Weissman, MS, LGC – Genetic Counselor, NorthShore University HealthSystem, Content Consultant

Disclosure Statement
In order to assure the highest quality of CME programming, and to comply with the ACCME Standards for Commercial Support, the AMA requires that all faculty, planning committee members and members of the AMA CME Program Committee disclose relevant financial relationships with any commercial or proprietary entity producing health care goods or services relevant to the content being planned or presented.

The following disclosure was provided:

• Scott Weissman, MS. LGC discloses Genetic Counselor relationship with Informed Medical Decisions.

No other individuals involved in the planning, review or delivery of this content have any relevant relationships to disclose.

Bibliography
•  NCCN Colorectal Cancer Screening Guidelines, V.2.2011. nccn.org/professionals/physician_gls/f_guidelines.asp
•  ACG Guidelines for Colorectal Cancer Screening 2009. http://s3.gi.org/physicians/guidelines/CCSJournalPublicationFebruary2009.pdf
•  Vasen, H., Watson, P., Mecklin, J.-P., & Lynch, H. (1999). New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) proposed by the International Collaborative Group on HNPCC. Gastroenterology, 116(6), 1453–1456.
•  Jasperson, KW, et al. (2010) Hereditary and familial colon cancer. Gastroenterology, 138:6
•  Surgeon General’s “My Family Health Portrait” at https://familyhistory.hhs.gov.
•  Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group (2009). Recommendations from the EGAPP Working Group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch syndrome relatives, Genetics in Medicine, 11(1), 35-41.
•  Hendriks, Y. M., de Jong, A. E., Morreau, H., Tops, C. M., Vasen, H. F., Wijnen, J. T., et al. (2006). Diagnostic approach and management of Lynch syndrome (hereditary nonpolyposis colorectal carcinoma): a guide for clinicians. CA: A Cancer Journal for Clinicians, 56(4), 213-225.
•  Umar, A., Boland, C. R., Terdiman, J. P., Syngal, S., de la Chapelle, A., Ruschoff, J., et al. (2004). Revised Bethesda Guidelines for hereditary nonpolyposis colorectal cancer (Lynch syndrome) and microsatellite instability. J Natl Cancer Inst, 96(4), 261–268.
•  Riley BD, Culver JO, Skrzynia C et al. (2011) Essential elements of genetic cancer risk assessment, counseling, and testing: Updated recommendations of the National Society of Genetic Counselors. Journal of Genetic Counseling [epub ahead of print]. Available at www.springerlink.com/content/ax33415046874623/.
•  American Society of Clinical Oncology. (2003) ASCO Statement Update: Genetic testing for cancer susceptibility. Journal of Clinical Oncology 21: 2397–2406.
•  Schneider KA. (2002) Counseling about cancer: Strategies for genetic counseling. 2nd edition. New York: Wiley-Liss.
•  Genetic Information Nondiscrimination Act (GINA) www.nchpeg.org/documents/GINA_discussion_guide_2june10.pdf.
•  US Multi-Society Task Force on Colorectal Cancer, and the American College of Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the Screening and Surveillance for the Early Detection of Colorectal Cancer and Radiology (2008). CA: a Cancer Journal for Clinicians, 58, 130–160. Accessed December 6, 2010 from http://caonline.amcancersoc.org/cgi/reprint/58/3/130
•  Lindor, N. M., Petersen, G. M., Hadley, D. W., Kinney, A. Y., Miesfeldt, S., Lu, K. H., et al. (2006). Recommendations for the care of individuals with an inherited predisposition to Lynch syndrome: a systematic review. JAMA, 296(12), 1507–1517.
•  Nielsen, M., Franken, P. F., Reinards, T. H., Weiss, M. M., Wagner, A., van der Klift, H., et al. (2005). Multiplicity in polyp count and extracolonic manifestations in 40 Dutch patients with MYH associated polyposis coli (MAP). Journal of Medical Genetics, 42(9), e54.
•  Winawer, S., Fletcher, R., Rex, D., Bond, J., Burt, R., Ferrucci, J., et al. (2003). Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence. Gastroenterology, 124(2), 544–560.

Should you have any questions regarding this activity please contact Katie Johansen Taber at katherine.johansen@ama-assn.org or 312-464-4964.

Should you have technical questions, please contact the AMA Unified Service Center at 800-621-8335.


Type:     Internet Activity (Enduring Material)
FREE
Activity Price
376 Registered Users
Credits
6 Credits> AMA> AMA PRA Category 1 Credit

0 Credits> AMA> Certificate of Participation for Non-Physicians