Screening colonoscopy: is it time?

2 recent articles9,10 in the New England.Journal of Medicine have dramatically raised the ante on this question. In a multicentre Veterans Affairs study conducted by David Lieberman and colleagues9 over 3000 asymptomatic subjects, aged 50 to 75 years, underwent colonoscopic examinations; 37.5% had a...

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Bibliographic Details
Published in:Canadian Medical Association journal (CMAJ) 2000-11, Vol.163 (10), p.1277-1278
Main Author: Simon, J B
Format: Article
Language:English
Subjects:
Aged
Canada
Colonic Neoplasms - mortality
Colonic Neoplasms - prevention & control
Colonoscopy - economics
Colorectal cancer
Cost-Benefit Analysis
Health Policy
Humans
Mass Screening - economics
Middle Aged
Objectives
Predictive Value of Tests
Public health
Sigmoidoscopy - economics
Testing
United States - epidemiology
Online Access:Get full text
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Summary:2 recent articles9,10 in the New England.Journal of Medicine have dramatically raised the ante on this question. In a multicentre Veterans Affairs study conducted by David Lieberman and colleagues9 over 3000 asymptomatic subjects, aged 50 to 75 years, underwent colonoscopic examinations; 37.5% had at least 1 adenoma and 10.5% had advanced neoplasia (defined as an adenoma with a diameter of at least 1 cm or with villous features, high-grade dysplasia or invasive cancer). Thomas Imperiale and colleagues10 similarly screened almost 2000 asymptomatic subjects over the age of 50 and found advanced neoplasia in 5.6%. The higher prevalence in Lieberman's study may partly reflect the inclusion of subjects at greater risk because of a family history of colon cancer, but nevertheless it is clear that a significant minority of asymptomatic individuals harbour dangerous colonic polyps or early malignancy. Importantly, in both studies fully half of the patients with advanced lesions in the proximal portion of the colon had no adenomas in the distal bowel,9,10 so sigmoidoscopic results for these subjects would have been normal.
ISSN:0820-3946
1488-2329