Protection From Colorectal Cancer After Colonoscopy

Brenner, Hermann; Chang‐Claude, Jenny; Seiler, Christoph M.; Rickert, Alexander; Hoffmeister, Michael

doi:10.7326/0003-4819-154-1-201101040-00004

Cited by 698 publications

(243 citation statements)

References 44 publications

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“…Based on subsequent articles and research, transition from normal epithelium to adenoma and carcinoma is associated with acquired molecular events, including loss of methyl groups in DNA, activated oncogenes, such as K-ras mutation and inactivation of p53 gene [5,6]. Thus, colonoscopy with detection and removal of adenomas is considered a powerful tool to reduce colorectal cancer (CRC) incidence in nowadays [7].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Immunohistochemical Staining Pattern of the mTOR Signaling Proteins in Colorectal Cancers and Adenoma Lesions

Kim

Lee

2017

Korean J Clin Lab Sci.

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Section: Introductionmentioning

confidence: 99%

Evaluation of the Immunohistochemical Staining Pattern of the mTOR Signaling Proteins in Colorectal Cancers and Adenoma Lesions

Kim

Lee

2017

Korean J Clin Lab Sci.

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“…Mortality was reduced by 53% 10-23 years after polypectomy [8]. The reduction in mortality was demonstrated for the left-sided and, a few years later, also for the right-sided colon [41,42]. At the time Baxter et al [41] acquired their data, quality assurance programmes had barely been established.…”

Section: How Should Screening Be Performed?mentioning

confidence: 99%

How Can Screening Colonoscopy Be Optimized?

Waldmann

Reguła²,

Ferlitsch³

2014

Dig Dis

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Since the implementation of screening programmes, both the incidence and mortality of colorectal cancer have been decreasing. The choice of the preferred screening tool, however, is divergent and the adherence to screening programmes in most countries is still low. Cancer detection tests such as the guaiac faecal occult blood test (gFOBT) and the immunohistochemical FOBT (iFOBT) achieve higher acceptance than endoscopy. The sensitivity and specificity of iFOBT are higher than those of gFOBT, but gFOBT is cheaper and easier to perform. Endoscopic screening, which represents cancer prevention tests, has higher sensitivity for premalignant lesions than gFOBT and iFOBT and enables diagnosis and therapy in one single procedure. Since screening colonoscopy and sigmoidoscopy are invasive procedures with potentially severe adverse events, the highest possible quality must be provided. High-tech equipment, experience, training, quality control programmes, excellent bowel preparation and low adverse event rates are pivotal. Alternative screening tools such as CT colonography, barium enema CT and multitarget stool DNA tests have not been established as routine screening tools to date.

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“…These lesions are easily missed as they are usually flat and often covered by a mucus cap. However, data from Germany suggest that the protective effect of colonoscopy in the right colon has recently improved [22]. Much effort has been put into decreasing the neoplasia miss rate by improvement of colonoscopy technique and imaging capability of endoscopes.…”

Section: Colonoscopymentioning

confidence: 99%

“…First, the reduction of FOBT on CRC mortality is due to colonoscopies being performed in case of a positive test. Second, case-control studies from the USA, Canada and Germany suggest a reduction of CRC mortality and incidence by colonoscopy [20,21,22]. Third, the reduction in incidence and mortality of distal CRC found in the sigmoidoscopy trials should be applicable to the whole colon for colonoscopy.…”

Section: Colonoscopymentioning

confidence: 99%

Controversies in Colorectal Cancer Screening

Pox¹

2014

Digestion

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Background: Colorectal cancer (CRC) is one of the most common cancers worldwide and a good candidate for screening programmes. However, there is controversy concerning which of the available screening tests should be used. Summary: There is general agreement that screening for CRC in the asymptomatic population should begin at the age of 50. Several different screening methods are available which can be separated into those that mainly detect cancers: faecal occult blood tests [guaiac (FOBT) and immunochemical (FIT)], genetic stool tests, blood tests and the M2-pyruvate kinase (M2-PK) test. Methods that detect cancers and polyps are colonoscopy, sigmoidoscopy, CT-colonography (CT-C) and colon capsule endoscopy. The only tests for which a reduction in CRC mortality compared to no screening have been proven in randomized trials are FOBT and sigmoidoscopy. Several trials suggest that FIT are superior to FOBT in terms of detection rates of cancers and advanced adenomas and possibly compliance. There is indirect evidence suggesting efficacy of colonoscopy as a screening test. The role of CT-C is controversial. There is data suggesting a good sensitivity for neoplasia >9 mm with a lower sensitivity for smaller neoplasia. However, radiation exposure is considered a major limitation in some countries. Unresolved questions include the lesion cut-off for referral to colonoscopy and work-up of extracolonic findings. For other methods, like genetic stool testing using newer markers, blood tests, capsule endoscopy and M2-PK, there is currently insufficient data on screening of the asymptomatic population. Key Messages: Colorectal screening is recommended and should be performed in the form of an organized programme. If detection of early-stage cancers is the aim of a screening programme, FIT seem to be superior to FOBT. If detection and removal of adenomas is the aim of a screening programme, endoscopic methods seem to be good alternatives. Sigmoidoscopy is easier to perform but will likely only have an effect on distal cancers. Colonoscopy is more invasive but enables inspection of the whole colon. The role of CT-C, capsule endoscopy, genetic stool tests, blood tests and M2-PK is currently unknown.

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Protection From Colorectal Cancer After Colonoscopy

Abstract: German Research Council and German Federal Ministry of Education and Research.

Cited by 698 publications

References 44 publications

Evaluation of the Immunohistochemical Staining Pattern of the mTOR Signaling Proteins in Colorectal Cancers and Adenoma Lesions

Evaluation of the Immunohistochemical Staining Pattern of the mTOR Signaling Proteins in Colorectal Cancers and Adenoma Lesions

How Can Screening Colonoscopy Be Optimized?

Controversies in Colorectal Cancer Screening

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