There is no debate that colonoscopies are vital for the early detection and treatment of cancers of the colon and rectum. Colorectal cancer is the third most deadly cancer among American men and women. The American Cancer Society recommends people begin regular colon screenings at age 50 or earlier if they have a family history of the disease or are presenting bothersome symptoms.

But the procedure is no cakewalk. It involves a one- to two-day prep of cleansing the bowel with a laxative solution that can make patients sick, if not uncomfortable. For the procedure, patients are sedated and a surgeon runs a thin, flexible scope into the colon to look for signs of cancer or polyps, which can be immediately removed.

Because of the uncomfortable nature of the exam, doctors worry that too few people actually have colonoscopies. And those who require follow-up exams may be less inclined to go.

Researchers analyzed data from 3,627 participants in a National Cancer Institute-sponsored trial and found “significant underuse” of surveillance colonoscopy among those considered high-risk for colorectal cancer. Within five years of an initial colonoscopy, only 58.3 percent of patients with advanced precancerous growths had a follow-up colonoscopy, which is typically recommended every three year for such patients.

But even more surprising, researchers also found what they called “substantial overuse” of surveillance colonoscopies among people considered low-risk for colorectal cancer.

“This is a clear example of an intervention not being utilized in relation to the risk,” said Dr. Robert Schoen, senior investigator of the study. The report appears in the latest issue of the journal Gastroenterology.

Source: Reuters

SOURCE: Fleet Attorney › Too many colonoscopies performed on those at low risk for colon cancer

The study focused on the rate of interval colorectal cancer in patients participating in the Polyp Prevention Trial Continued Follow-up Study, a four-year multicenter, randomized, controlled trial designed to examine the effects of a low-fat, high-fiber, high-fruit and vegetable diet on the recurrence of colorectal adenomas, or precancerous polyps. The University of Pittsburg study on the occurrence of interval colorectal cancer appears in the January issue of GIE: Gastrointestinal Endoscopy, the monthly scientific journal of the American Society for Gastrointestinal Endoscopy.

“Despite regular colonoscopy, interval colorectal cancer may occur,” says study lead author Robert E. Schoen. “We set out to examine the rate at which these interval cancers appear.”

The study found that nine cases of colorectal cancer were diagnosed over 7,626 person-years of observation, or a rate of 1.2 per 1,000 person-years of observation. In patients involved in the study who developed colorectal cancer, 78 percent had a history of precancerous polyps. The majority – about 78 percent – were detected at an early stage and thus were considered highly curable.

Colonoscopies are the “gold standard” for detection of colorectal cancer. Screenings are recommended for all individuals beginning at age 50 or earlier for people with a history of colorectal cancer or who are exhibiting symptoms such as blood in the stool. During colonoscopy exams, doctors can detect and remove polyps, some of which can become cancerous if not removed.

SOURCE: Fleet Attorney › Study shows need for thorough polyp removal, continued surveillance

Colorectal cancer is the third most common cancer diagnosed in both men and women and the second leading cause of cancer-related deaths among men and women combined in the United States, according to the American Cancer Society. The lifetime risk of developing colorectal cancer is about 1 in 19. Currently, the best defense against colorectal cancer is routine colonoscopies.

While colonoscopies carry few risks, the elderly do experience a higher percentage of complications from the procedure. Preparing for the colonoscopy may also present problems for some patients. Earlier this year the Food and Drug Administration (FDA) placed a black box warning – its strongest warning possible – on prescription oral sodium phosphate (OSP) products used to cleanse the bowel prior to colonoscopy, Visicol and Osmo Prep. The products have been associated with a rare kidney injury known as acute phosphate nephropathy.

The same concern was placed on over-the-counter OSP products such as those made by Fleet. The FDA warning prompted Fleet to remove its OSP products from store shelves.

Source: Technology Review

SOURCE: Fleet Attorney › Vaccine may eliminate need for routine colon screenings