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

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...

<p>Association of Cardiovascular Risk Assessment with Early Colorectal Neoplasia Detection in Asymptomatic Population: A Systematic Review and Meta-Analysis</p>

“…[15][16][17] Various risk scores have also been developed for predicting advanced colorectal neoplasia (AN). [18][19][20][21][22][23][24] Although several studies 25,26 have reported that elevated blood lipids, the well documented CVD risk factor, and history of CVD were associated with increased risk of CRC, the majority of risk scores developed for AN did not include them into the models. 27 Recent studies have reported the associations between CVD risk assessment and risk of`1 CRN.…”

Comparison of biomarker expression between proximal and distal colorectal adenomas: The Tennessee–Indiana Adenoma Recurrence Study

“…Although small adenomas (<10 mm) are evenly distributed [18,19], advanced adenomas are more predominant in the distal colorectum [20][21][22][23][24]. A recent analysis of more than 1.2 million CRC cases suggested that adenoma initiation rates were higher for proximal tumors, whereas growth rates were higher for distal tumors [25].…”