Colorectal cancer screening: Clinical guidelines and rationale

Sj, Winawer; Fletcher, R. H.; Miller, Lesley-Ann; Godlee, Fiona; Stolar, MH; Mulrow, CD; Woolf, SH; Glick, S N; Tg, Ganiats; Jh, Bond; Rosen, Lester; Zapka, J. G.; Olsen, Sharon J.; Giardiello, F. M.; Sisk, JE; Antwerp, R Van; Brown-Davis, Carolyn; Marciniak, DA; Mayer, R. John

doi:10.1053/gast.1997.v112.agast970594

Cited by 1,622 publications

(990 citation statements)

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“…Hintergrund Die KRK-Inzidenz steigt ab einem Alter von 50 Jahren deutlich an [92,93]. In einer prospektiven Koloskopiestudie zeigte sich eine deutlich niedrigere Nachweisrate fortgeschrittener Adenome bei 40-bis 49-Jährigen (3,5 %) [94].…”

Section: Starker Konsensunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

147

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Section: Starker Konsensunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

147

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“…This policy was established in 1988, before the publication of American Gastroenterological Association guidelines for CRC screening. 16 Patients were excluded if they had undergone colonoscopy or sigmoidoscopy in the previous 5 years or reported hematochezia, change in bowel habit, or persistent abdominal or rectal pain. Other exclusion criteria were age less than 40 years or greater than 90 years; iron deficiency anemia; weight loss; history of colon polyps or cancer; a first-degree relative with CRC; a history of breast or uterine cancer, inflammatory bowel disease, abdominal radiation, colonoscopy, or barium enema within the previous 5 years, performed for any indication; and use of anticoagulant medication.…”

Section: Patientsmentioning

confidence: 99%

“…13 These recommendations now are endorsed by the American Cancer Society, 14 the World Health Organization, 15 and by virtually all medical and surgical professional societies concerned with digestive diseases. 16,17 A positive FS or FOBT result is an indication for colonoscopy. The continuing high mortality rates for patients with CRC, together with two large studies that demonstrate that FS fails to identify a substantial proportion of proximal lesions, 18,19 have led many specialists to regard reliance on FS or FOBT alone as screening tests would be as wrong as mammography of a single breast in screening for breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of distal colonic polyps for prediction of advanced proximal neoplasia in an average-risk population undergoing screening colonoscopy

Ibáñez

Muñoz-Navas

Duque

et al. 2004

Gastrointestinal Endoscopy

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BACKGROUNDFor colorectal cancer screening, the predictive value of distal findings in the ascertainment of proximal lesions is not fully established. The aims of this study were to assess distal findings as predictors of advanced proximal neoplasia and to compare the predictive value of endoscopy alone vs. combined endoscopic and histopathologic data. METHODSPrimary colonoscopy screening was performed in 2210 consecutive, average-risk adults. Age, gender, endoscopic (size, number of polyps), and histopathologic distal findings were used as potential predictors of advanced proximal neoplasms (i.e., any adenoma ≥1 cm in size, and/or with villous histology, and/or with severe dysplasia or invasive cancer). Polyps were defined as distal if located in the descending colon, the sigmoid colon, or the rectum. Those in other locations were designated proximal. RESULTSNeoplastic lesions, including 11 invasive cancers, were found in 617 (27.9%) patients. Advanced proximal neoplasms without any distal adenoma were present in 1.3% of patients. Of the advanced proximal lesions, 39% were not associated with any distal polyp. Older age, male gender, and distal adenoma were independent predictors of advanced proximal neoplasms. The predictive ability of a model with endoscopic data alone did not improve after inclusion of histopathologic data. In multivariate logistic regression analysis, the predictive ability of models that use age, gender, and any combination of distal findings was relatively low. The proportion of advanced proximal neoplasms identified if any distal polyp was an indication for colonoscopy was only 62%. CONCLUSIONSA strategy in which colonoscopy is performed solely in patients with distal colonic findings is not effective screening for the detection of advanced proximal neoplasms in an average-risk population.Reprint requests: Maite Betés Ibáñez, MD, PhD, Departamento de Digestivo, Clínica Universitaria de Navarra, 31080 Pamplona, Spain. INTRODUCTIONMost colorectal cancers (CRC) develop from adenomas, 1-3 which have a long, asymptomatic phase during which they are detectable and curable. Excision of colorectal adenomas reduces the incidence and the mortality of CRC. 2,4-11 Therefore, CRC fulfills the criteria for benefit from screening. 12 In 1996, the United States Preventive Services Task Force recommended screening of asymptomatic adults over 50 years of age with either flexible sigmoidoscopy (FS) or fecal occult blood tests (FOBT). 13 These recommendations now are endorsed by the American Cancer Society, 14 the World Health Organization, 15 and by virtually all medical and surgical professional societies concerned with digestive diseases. 16,17 A positive FS or FOBT result is an indication for colonoscopy. The continuing high mortality rates for patients with CRC, together with two large studies that demonstrate that FS fails to identify a substantial proportion of proximal lesions, 18,19 have led many specialists to regard reliance on FS or FOBT alone as screening tests would be as wrong as mammography o...

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“…Prior analyses have not considered that the impact of cancer on a patient's risk of death may be diminished among patients with higher comorbidity 11,12 . Further, while prior work has stratified patients into life expectancy groups, comorbidity was not incorporated into the approach [13][14][15][16][17][18] . Finally, prior work has not accounted for the fact that increasing age and declining health would increase one's susceptibility to the risk of SC-associated complications 11,12 .…”

Section: Introductionmentioning

confidence: 99%