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Volume 343:162-168 July 20, 2000 Number 3 Next

	Full Text PDF Editorial by Podolsky, D. K. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

ABSTRACT

Background and Methods The role of colonoscopy in screening for colorectal cancer is uncertain. At 13 Veterans Affairs medical centers, we performed colonoscopy to determine the prevalence and location of advanced colonic neoplasms and the risk of advanced proximal neoplasia in asymptomatic patients (age range, 50 to 75 years) with or without distal neoplasia. Advanced colonic neoplasia was defined as an adenoma that was 10 mm or more in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. In patients with more than one neoplastic lesion, classification was based on the most advanced lesion.

Results Of 17,732 patients screened for enrollment, 3196 were enrolled; 3121 of the enrolled patients (97.7 percent) underwent complete examination of the colon. The mean age of the patients was 62.9 years, and 96.8 percent were men. Colonoscopic examination showed one or more neoplastic lesions in 37.5 percent of the patients, an adenoma with a diameter of at least 10 mm or a villous adenoma in 7.9 percent, an adenoma with high-grade dysplasia in 1.6 percent, and invasive cancer in 1.0 percent. Of the 1765 patients with no polyps in the portion of the colon that was distal to the splenic flexure, 48 (2.7 percent) had advanced proximal neoplasms. Patients with large adenomas (10 mm) or small adenomas (<10 mm) in the distal colon were more likely to have advanced proximal neoplasia than were patients with no distal adenomas (odds ratios, 3.4 [95 percent confidence interval, 1.8 to 6.5] and 2.6 [95 percent confidence interval, 1.7 to 4.1], respectively). However, 52 percent of the 128 patients with advanced proximal neoplasia had no distal adenomas.

Conclusions Colonoscopic screening can detect advanced colonic neoplasms in asymptomatic adults. Many of these neoplasms would not be detected with sigmoidoscopy.

Source Information

From the Veterans Affairs medical centers in Portland, Oreg. (D.A.L.); Perry Point, Md. (D.G.W.); Minneapolis (J.H.B.); Denver (D.J.A.); Tucson, Ariz. (H.G.); and Hines, Ill. (G.C.). Other authors were William V. Harford, M.D., Dallas; Dawn Provenzale, M.D., Durham, N.C.; Steve Sontag, M.D., and Tom Schnell, M.D., Hines, Ill.; Donald R. Campbell, M.D., Kansas City, Mo.; Theodore E. Durbin, M.D., Long Beach, Calif.; Doug B. Nelson, M.D., and Steve L. Ewing, M.D., Minneapolis; George Triadafilopoulos, M.D., Palo Alto, Calif.; Francisco C. Ramirez, M.D., Phoenix, Ariz.; John G. Lee, M.D., Judith F. Collins, M.D., M. Brian Fennerty, M.D., Tiina K. Johnston, Ed.M., and Christopher L. Corless, M.D., Ph.D., Portland, Oreg.; Kenneth R. McQuaid, M.D., San Francisco; Richard E. Sampliner, M.D., Thomas G. Morales, M.D., and Ronnie Fass, M.D., Tucson, Ariz.; and Robert Smith, M.D., and Yogesh Maheshwari, M.D., White River Junction, Vt. — all at Veterans Affairs medical centers.

Address reprint requests to Dr. Lieberman at the Division of Gastroenterology, Oregon Health Sciences University, Portland Veterans Affairs Medical Center, P3-GI, P.O. Box 1034, Portland, OR 97207.

Full Text of this Article

Related Letters:

Screening for Colorectal Cancer
Sherrick R. C., O'Brien K., O'Connell R., O'Connell M., Ault M. J., Mandel S. A., Theuer C. P., Taylor T. H., Anton-Culver H., Lieberman D., Imperiale T. F., Ransohoff D. F., Podolsky D. K.
Extract | Full Text  
N Engl J Med 2000; 343:1651-1654, Nov 30, 2000. Correspondence

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