Use of Colonoscopy As A Primary Screening Test for Colorectal Cancer in Average Risk People

Abstract

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...

Cutoff value determines the performance of a semi-quantitative immunochemical faecal occult blood test in a colorectal cancer screening programme

“…This is in line with other studies (Manus et al, 1997;Betes et al, 2003;Sedjo et al, 2007). Thus, the diagnostic yield increases with age and male gender.…”

Fecal Calprotectin Levels in Patients with Colonic Polyposis

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Histomorphological Profile of Colonoscopic Biopsies - A Two Year Study in a Tertiary Care Hospital in South India

“…Present study encountered 2 cases of intestinal tuberculosis with equal sex incidence and mean age of presentation of 63 years, which mirrors the findings of Leung VKS et al [16] Screening for colorectal cancer by colonoscopy with removal of precancerous lesions is a powerful and effective approach for reducing colorectal cancer incidence and mortality, therefore it is now considered as gold standard for the diagnosis of colorectal cancer. [17] Amongst 21 colonoscopic biopsies diagnosed as malignant lesions, 17 were of adenocarcinoma, 2 of mucin secreting carcinoma and remaining 2 of signet ring cell carcinoma. These lesions showed male preponderance and majority of the patients were above 40 years similar to the observations of Phillipoet al [18] In the present study, the patients less than 40 years of age tended to have poor prognostic tumors such as mucinous and signet ring cell carcinoma, this finding concurs with previous studies.…”