American Board of Internal Medicine (ABIM) Certification Practice Exam

What constitutes above average risk for colon cancer?

1. Family history of colorectal cancer after age 60

2. History of benign polyps

3. Family history of an advanced adenoma

4. Age over 50 with no family history

The correct answer is: Family history of an advanced adenoma

The determination of above average risk for colon cancer is critical for guiding screening recommendations and preventive measures. A family history of advanced adenomas significantly raises the risk for colorectal cancer. Advanced adenomas are types of polyps that have dysplastic features and are more likely to progress to cancer than other types of polyps. Individuals with a family history of such adenomas—especially in first-degree relatives—are considered to have an increased risk, which warrants earlier and more frequent screening. In contrast, a family history of colorectal cancer occurring after age 60, a history of benign polyps, and age over 50 with no family history do not confer the same level of risk. While these factors may increase the general population risk for colon cancer, they do not meet the criteria for above-average risk, which typically requires a stronger familial connection or more severe findings, like advanced adenomas.