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Screening for colon malignancy with colonoscopy.

D A Lieberman1, F W Smith

  • 1Veterans Administration Medical Center, Portland, Oregon.

The American Journal of Gastroenterology
|August 1, 1991
PubMed
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Flexible sigmoidoscopy screening for colon cancer in asymptomatic men has low sensitivity. This study found sigmoidoscopy detected only 44% of adenomatous polyps, missing many proximal lesions.

Area of Science:

  • Gastroenterology
  • Oncology
  • Preventive Medicine

Background:

  • Screening for colon cancer aims to reduce mortality.
  • Flexible sigmoidoscopy is a common screening tool, but its sensitivity in asymptomatic individuals is not well-established.
  • Previous studies have not adequately assessed sigmoidoscopy's effectiveness in detecting polyps in asymptomatic populations.

Purpose of the Study:

  • To determine the prevalence and location of polyps and cancers in an asymptomatic population using full colonoscopy.
  • To assess the sensitivity of screening flexible sigmoidoscopy to 60 cm.
  • To identify the proportion of patients with adenomas or cancer who had index adenomatous polyps in the distal 60 cm.

Main Methods:

  • One hundred five healthy male outpatients over 50 years old with negative fecal occult blood tests and no prior colon pathology underwent full colonoscopy.

Related Experiment Videos

  • A careful examination of the distal 60 cm was performed, followed by examination to the cecum.
  • Patients were categorized into three groups based on findings in the distal 60 cm.

    • Main Results:

    • Forty-three percent of patients had adenomatous polyps; only 19% had an index polyp in the distal 60 cm, resulting in a sigmoidoscopy sensitivity of 44%.
    • Adenoma prevalence increased with age.
    • A significant number of patients with normal distal findings (28%) or hyperplastic polyps (29%) had proximal adenomas, as did 42% of those with distal adenomas.

    Conclusions:

    • Adenomatous polyps are prevalent in asymptomatic men with negative fecal occult blood tests.
    • Flexible sigmoidoscopy to 60 cm demonstrates low sensitivity (44%) for detecting patients with adenomatous polyps in this population.
    • Full colonoscopy is recommended for comprehensive screening due to the high rate of missed proximal lesions with sigmoidoscopy alone.