Flexible sigmoidoscopy may be ineffective for secondary prevention of colorectal cancer in asymptomatic, average-risk men

Pg, Foutch; Mai, Hugh; Pardy, K.; DiSario, James A.; Manne, Rao K.; Kerr, David

doi:10.1007/bf01297142

Cited by 109 publications

(40 citation statements)

References 28 publications

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“…Rex et al (13) reported that 15% of asymptomatic men and 7% of women aged 60 yr or older had advanced colorectal neoplasms. Similar percentages had been found in small clinical series and autopsy studies (11,12,14,(40)(41)(42). We found a linear association between age and the prevalence of advanced colonic neoplasia.…”

Section: Discussionsupporting

confidence: 74%

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Use of colonoscopy as a primary screening test for colorectal cancer in average risk people*1

Betés

2003

The American Journal of Gastroenterology

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OBJECTIVEThe use of colonoscopy as a primary screening test for colorectal cancer (CRC) in average risk adults is a subject of controversy. Our primary objective was to build a predictive model based on a few simple variables that could be used as a guide for identifying average risk adults more suitable for examination with colonoscopy as a primary screening test. METHODSThe prevalence of advanced adenomas was assessed by primary screening colonoscopy in 2210 consecutive adults at least 40 yr old, without known risk factors for CRC. Age, gender, and clinical and biochemical data were compared among people without adenomas, those with nonadvanced adenomas, and those with any advanced neoplasm. A combined score to assess the risk of advanced adenomas was built with the variables selected by multiple logistic regression analysis. RESULTSNeoplastic lesions were found in 617 subjects (27.9%), including 259 with at least one neoplasm that was 10 mm or larger, villous, or with moderate-to-severe dysplasia, and 11 with invasive cancers. Advanced lesions were more frequent among men, older people, and those with a higher body mass index (BMI). These three variables were independent predictors of advanced adenomas in multivariate analysis. A score combining age, sex, and BMI was developed as a guide for identifying individuals more suitable for screening colonoscopy. CONCLUSIONSAge, gender, and BMI can be used to build a simple score to select those average risk adults who might be candidates for primary screening colonoscopy.Reprint requests and correspondence: Maria Teresa Betés Ibáñez, M.D. Departamento de Digestivo, Clínica Universitaria de Navarra 31080 Pamplona, Spain. INTRODUCTIONColorectal cancer (CRC) is the second most frequent cause of cancer-related death in western countries (1). Most cancers develop from benign adenomatous polyps (2, 3), in subjects with no known risk factors for the disease (4). Although it is not yet possible to determine which adenomas will progress to cancer, certain pathological features have been found to correlate with the risk of progressing to CRC (3, 5). "Advanced adenomas" have been defined as those with at least one of the following characteristics: size 1 cm or larger, tubulovillous or villous histology, and moderate or severe dysplasia (6-9).Screening with full colonoscopy as a primary procedure has been limited to a few small series (10-16), and results have not been focused in advanced adenomas. Two large colonoscopic series recently published (17,18) have assessed the proportion of advanced proximal adenomas in average risk adults. Although the prevalence of colonic adenomas is higher among men than among women (5,12,19,20) and increases with age (11,13,15), more data are needed to adequately assess the independent role of the most relevant predictors of advanced adenomas (18). A variety of factors have been linked to the development of adenomas or CRC (21-25), but currently there is no dominant risk factor that could be practically used for risk stratification in screening...

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Section: Discussionsupporting

confidence: 74%

“…Screening with full colonoscopy as a primary procedure has been limited to a few small series (10)(11)(12)(13)(14)(15)(16), and results have not been focused in advanced adenomas. Two large colonoscopic series recently published (17,18) have assessed the proportion of advanced proximal adenomas in average risk adults.…”

Section: Introductionmentioning

confidence: 99%

Use of colonoscopy as a primary screening test for colorectal cancer in average risk people*1

Betés

2003

The American Journal of Gastroenterology

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“…[22][23][24][25][26][27][28][29][30][31][32][33][34][35] Only studies wherein colonoscopy is offered as a primary screening procedure can appropriately address this issue. Currently, such data that are available derive from 3 studies that comprise relatively few cases [36][37][38] and two large studies carried out in the United States. 18,19 These large studies from the United States assess the usefulness of applying endoscopic and histopathologic findings in the distal colon to predict the likelihood of finding advanced proximal neoplasms.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

Ibáñez

Muñoz-Navas

Duque

et al. 2004

Gastrointestinal Endoscopy

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BACKGROUNDFor colorectal cancer screening, the predictive value of distal findings in the ascertainment of proximal lesions is not fully established. The aims of this study were to assess distal findings as predictors of advanced proximal neoplasia and to compare the predictive value of endoscopy alone vs. combined endoscopic and histopathologic data. METHODSPrimary colonoscopy screening was performed in 2210 consecutive, average-risk adults. Age, gender, endoscopic (size, number of polyps), and histopathologic distal findings were used as potential predictors of advanced proximal neoplasms (i.e., any adenoma ≥1 cm in size, and/or with villous histology, and/or with severe dysplasia or invasive cancer). Polyps were defined as distal if located in the descending colon, the sigmoid colon, or the rectum. Those in other locations were designated proximal. RESULTSNeoplastic lesions, including 11 invasive cancers, were found in 617 (27.9%) patients. Advanced proximal neoplasms without any distal adenoma were present in 1.3% of patients. Of the advanced proximal lesions, 39% were not associated with any distal polyp. Older age, male gender, and distal adenoma were independent predictors of advanced proximal neoplasms. The predictive ability of a model with endoscopic data alone did not improve after inclusion of histopathologic data. In multivariate logistic regression analysis, the predictive ability of models that use age, gender, and any combination of distal findings was relatively low. The proportion of advanced proximal neoplasms identified if any distal polyp was an indication for colonoscopy was only 62%. CONCLUSIONSA strategy in which colonoscopy is performed solely in patients with distal colonic findings is not effective screening for the detection of advanced proximal neoplasms in an average-risk population.Reprint requests: Maite Betés Ibáñez, MD, PhD, Departamento de Digestivo, Clínica Universitaria de Navarra, 31080 Pamplona, Spain. INTRODUCTIONMost colorectal cancers (CRC) develop from adenomas, 1-3 which have a long, asymptomatic phase during which they are detectable and curable. Excision of colorectal adenomas reduces the incidence and the mortality of CRC. 2,4-11 Therefore, CRC fulfills the criteria for benefit from screening. 12 In 1996, the United States Preventive Services Task Force recommended screening of asymptomatic adults over 50 years of age with either flexible sigmoidoscopy (FS) or fecal occult blood tests (FOBT). 13 These recommendations now are endorsed by the American Cancer Society, 14 the World Health Organization, 15 and by virtually all medical and surgical professional societies concerned with digestive diseases. 16,17 A positive FS or FOBT result is an indication for colonoscopy. The continuing high mortality rates for patients with CRC, together with two large studies that demonstrate that FS fails to identify a substantial proportion of proximal lesions, 18,19 have led many specialists to regard reliance on FS or FOBT alone as screening tests would be as wrong as mammography o...

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“…there were already several cross sectional studies of colonoscopy in asymptomatic volunteers underway [2][3][4][5] , and the results were published in 1990 and 1991 [2][3][4][5] . These 4 studies eventually totaled just over 1000 patients [2][3][4][5][6] , and demonstrated that the prevalence of adenomas in asymptomatic persons is substantial, age-related, and higher in males [2][3][4][5][6] .…”

Section: Introduction and Historical Perspective On Screening Colonosmentioning

confidence: 99%

“…These 4 studies eventually totaled just over 1000 patients [2][3][4][5][6] , and demonstrated that the prevalence of adenomas in asymptomatic persons is substantial, age-related, and higher in males [2][3][4][5][6] .…”

Section: Introduction and Historical Perspective On Screening Colonosmentioning

confidence: 99%

Colonoscopy: The Current King of the Hill in the USA

Rex

2014

Dig Dis Sci

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Colonoscopy is the dominant colorectal cancer screening strategy in the United States.There are no randomized controlled trials completed of screening colonoscopy, but multiple lines of evidence establish that colonoscopy reduces colorectal cancer incidence in both the proximal and distal colon. Colonoscopy is highly operator dependent, but systematic efforts to measure and improve quality are impacting performance.Colonoscopy holds a substantial advantage over other strategies for detection of serrated lesions, and a recent case-control study suggests that once-only colonoscopy or colonoscopy at 20 year intervals, by a high level detector, could ensure lifetime protection from colorectal cancer for many patients. 3Introduction and historical perspective on screening colonoscopy

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Flexible sigmoidoscopy may be ineffective for secondary prevention of colorectal cancer in asymptomatic, average-risk men

Cited by 109 publications

References 28 publications

Use of colonoscopy as a primary screening test for colorectal cancer in average risk people*1

Use of colonoscopy as a primary screening test for colorectal cancer in average risk people*1

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

Colonoscopy: The Current King of the Hill in the USA

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