Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380
- PMID: 10900274
- DOI: 10.1056/NEJM200007203430301
Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380
Erratum in
- N Engl J Med 2000 Oct 19;343(16):1204
Abstract
Background and methods: The role of colonoscopy in screening for colorectal cancer is uncertain. At 13 Veterans Affairs Medical Centers, we performed colonoscopy to determine the prevalence and location of advanced colonic neoplasms and the risk of advanced proximal neoplasia in asymptomatic patients (age range, 50 to 75 years) with or without distal neoplasia. Advanced colonic neoplasia was defined as an adenoma that was 10 mm or more in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. In patients with more than one neoplastic lesion, classification was based on the most advanced lesion.
Results: Of 17,732 patients screened for enrollment, 3196 were enrolled; 3121 of the enrolled patients (97.7 percent) underwent complete examination of the colon. The mean age of the patients was 62.9 years, and 96.8 percent were men. Colonoscopic examination showed one or more neoplastic lesions in 37.5 percent of the patients, an adenoma with a diameter of at least 10 mm or a villous adenoma in 7.9 percent, an adenoma with high-grade dysplasia in 1.6 percent, and invasive cancer in 1.0 percent. Of the 1765 patients with no polyps in the portion of the colon that was distal to the splenic flexure, 48 (2.7 percent) had advanced proximal neoplasms. Patients with large adenomas (> or = 10 mm) or small adenomas (< 10 mm) in the distal colon were more likely to have advanced proximal neoplasia than were patients with no distal adenomas (odds ratios, 3.4 [95 percent confidence interval, 1.8 to 6.5] and 2.6 (95 percent confidence interval, 1.7 to 4.1], respectively). However, 52 percent of the 128 patients with advanced proximal neoplasia had no distal adenomas.
Conclusions: Colonoscopic screening can detect advanced colonic neoplasms in asymptomatic adults. Many of these neoplasms would not be detected with sigmoidoscopy.
Comment in
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Going the distance--the case for true colorectal-cancer screening.N Engl J Med. 2000 Jul 20;343(3):207-8. doi: 10.1056/NEJM200007203430309. N Engl J Med. 2000. PMID: 10900282 No abstract available.
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Screening for colorectal cancer.N Engl J Med. 2000 Nov 30;343(22):1651-2; author reply 1652-4. doi: 10.1056/NEJM200011303432214. N Engl J Med. 2000. PMID: 11184980 No abstract available.
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Screening for colorectal cancer.N Engl J Med. 2000 Nov 30;343(22):1651; author reply 1652-4. N Engl J Med. 2000. PMID: 11184981 No abstract available.
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Screening for colorectal cancer.N Engl J Med. 2000 Nov 30;343(22):1652; author reply 1652-4. N Engl J Med. 2000. PMID: 11184983 No abstract available.
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Colonoscopic screening of women for colorectal neoplasia.N Engl J Med. 2005 Aug 25;353(8):844-6; author reply 844-6. doi: 10.1056/NEJMc051651. N Engl J Med. 2005. PMID: 16120868 No abstract available.
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