Colorectal cancer detection with the 60 cm flexible sigmoidoscope in a solo general internist's office

Emphasis is placed on the importance of early detection of colorectal cancer by the primary care physician using the 60 cm flexible sigmoidoscope. A training format for this procedure is proposed. The author, trained according to this format, found 49 polyps and three carcinomas among his first 365 randomly chosen patients. Of these 317 (87%) were asymptomatic, having no risk factors. The average distance of insertion was 53 cm and the average examination time was 20 minutes. The calculated cost for these 365 patients was approximately +60,000, and the estimated average cost for a potentially curable colorectal cancer detection was approximately +20,000. Although a relatively long examination time may be necessary for the beginner, the author concludes that the primary care physician can be readily trained to handle the 60 cm flexible sigmoidoscope safely and cost effectively.