Initial experience with a general population colorectal cancer screening clinic

Recognition of adenoma to carcinoma progression has established colorectal cancer as a preventable malignancy. Colorectal cancer is, therefore, an ideal malignancy for preventative screening given the presence of a benign precursor. We set out to establish a pilot low-risk endoscopic screening clinic and we discuss our initial results.

A retrospective chart review of all patients referred to a new low-risk colorectal cancer endoscopic screening clinic from October 1, 2004 to September 30, 2005 was performed. Those patients found to have adenomas or carcinomas were analyzed further regarding location of neoplasm and pathologic findings.

A total of 379 low-risk patients attended the colorectal cancer screening clinics. The age range of the patients was 50 to 86 years. The male to female ratio was 254 to 128. A total of 257 patients had flexible sigmoidoscopy as the initial screen, 24 patients had partial colonoscopy, and 98 patients had complete initial colonoscopy. A total of 152 patients had polyps removed, of which 63 patients had adenomas, 3 had adenocarcinomas, 1 had a carcinoid, and the remaining had an assortment of nonneoplastic polyps. Of the 67 patients with neoplasms, 50 were left of the splenic flexure, 11 were right of the splenic flexure, and 5 patients had lesions both proximal and distal to the flexure. Thirty-two of the 67 patients had complete colonoscopy at the initial procedure and, thus far, 21 patients have had completion colonoscopies, of which 9 patients had further neoplasms identified beyond the splenic flexure. All 3 patients with carcinoma had early tumors resected with curative intent, with negative margins and negative nodes.

Our initial experience with a low-risk general population colorectal cancer endoscopic screening clinic yielded 18% of patients with neoplasms, and 1% had curable cancers resected.