Download PDF
Clin Colon Rectal Surg 2001; 14(4): 359-368
DOI: 10.1055/s-2001-18515
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Colorectal Cancer Screening and Surveillance

Philip E. Jaffe
  • Department of Gastroenterology, Cleveland Clinic Florida, Naples, FL
Further Information

Publication History

Publication Date:
19 November 2001 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Data from prospective and large retrospective studies indicate that colonoscopy is highly effective in screening average- and high-risk populations as well for surveillance in those with a prior history of colorectal polyps, cancer, or chronic colitis. Screening colonoscopy has been shown to be safe and important in detecting polyps and cancers that would have gone undetected had traditional screening measure been employed and appears to be cost-effective at levels at or below costs for other cancer screening programs. Colonoscopy with polypectomy leads to a greater than 75% reduction in colorectal cancer development when compared with historical controls. Surveillance intervals for patients with a history of adenomatous colon polyps can be extended to at least 3 to 5 years under most circumstances. Colonoscopy following curative colorectal cancer surgery should follow typical postpolypectomy recommendations given the major goal of preventing a second primary colorectal cancer in this group.

KEYWORD

Colon - colonoscopy - cancer - polyp - screening

REFERENCES

  • 1 Landis S, Murray T, Bolden S, Wingo P. Cancer Statistics.  CA Cancer J Clin . 1999;  49 8-31
    CrossrefPubMedSearch in Google Scholar
  • 2 Waters T, Weinberg P, Bennett C. Health economics in the treatment of colorectal cancer.  Canc Invest . 1998;  16 582-587
    PubMedSearch in Google Scholar
  • 3 Seifeldin R, Hantsch J. The economic burden associated with colon cancer in the United States.  Clin Ther . 1999;  21 1370-1379
    CrossrefPubMedSearch in Google Scholar
  • 4 Everhart J, Sandler R, Donowitz M. The burden of gastrointestinal diseases. Colorectal cancer. Bethesda, MD: American Gatroenterology Association Publications 2001: 51-59
    Search in Google Scholar
  • 5 Bond J. Colorectal surveillance for neoplasia; an overview.  Gastrointest Endosc . 1999;  49 S35-S40
    PubMedSearch in Google Scholar
  • 6 Smalley W, Eisen G. Colorectal cancer screening 2000; the role of colonoscopy in average-risk individuals.  Curr Gastroenterol Rep . 2000;  2 406-412
    PubMedSearch in Google Scholar
  • 7 Atkin W, Morson B, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas.  N Engl J Med . 1992;  326 658-662
    CrossrefPubMedSearch in Google Scholar
  • 8 Selby J, Friedman G D, Quesenberry C. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer.  N Engl J Med . 1992;  326 653-657
    CrossrefPubMedSearch in Google Scholar
  • 9 Mandel J, Bond J, Bradley M. Sensitivity, specificity, and positive predictivity of the Hemoccult test in screening for colorectal cancers.  Gastroenterology . 1989;  97 597-600
    PubMedSearch in Google Scholar
  • 10 Winawer S, Stewart E, Zauber A. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy.  N Engl J Med . 2000;  342 1766-1772
    CrossrefPubMedSearch in Google Scholar
  • 11 Fenlon H, Nunes, Schroy P. A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps.  N Engl J Med . 1999;  341 1496-5103
    CrossrefPubMedSearch in Google Scholar
  • 12 Winawer S. Colon surveillance for neoplasia. Appropriate intervals for surveillance.  Gastrointest Endosc . 1999;  49 S63-S66
    PubMedSearch in Google Scholar
  • 13 Sonnenberg A, Delco F, Inadomi J. Cost-effectiveness of colonoscopy in screening for colorectal cancer.  Ann Intern Med . 2000;  133 573-584
    CrossrefPubMedSearch in Google Scholar
  • 14 Lieberman D, Weiss D, Bond J. Use of colonoscopy to screen asymptomatic adults for colorectal cancer.  N Engl J Med . 2000;  343 162-168
    CrossrefPubMedSearch in Google Scholar
  • 15 Imperiale T, Wagner D, Lin C. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings.  N Engl J Med . 2000;  343 169-174
    CrossrefPubMedSearch in Google Scholar
  • 16 U.S. Department of Health and Human Services, Federal Register 2001 . 
  • 17 Burt R. Colon surveillance for neoplasia. Impact of family history on screening and surveillance.  Gastrointest Endosc . 1999;  49 S41-S49
    PubMedSearch in Google Scholar
  • 18 Pariente A, Milan C, Lafon J. Colonoscopic screening in first-degree relatives of patients with sporadic colorectal cancer: a case-control study.  Gastroenterology . 1998;  115 7-12
    PubMedSearch in Google Scholar
  • 19 Wijnen J, Vasen J, Khan P. Clinical findings with implications for genetic testing in families with clustering of colorectal cancer.  N Engl J Med . 1998;  339 511-518
    CrossrefPubMedSearch in Google Scholar
  • 20 Rex D, Johnson D, Lieberman D. ACG recommendations on colorectal cancer screening for average and high risk patients in clinical practice.  Am Coll Gastroenterol . 2000;  1 1-25
    PubMedSearch in Google Scholar
  • 21 Rodriguez-Bigas M, Boland M, Hamilton S. A National Cancer Institute workshop on hereditary nonpolyposis colorectal cancer syndrome: meeting highlights and Bethesda guidelines.  J Natl Cancer Inst . 1997;  89 1758-1762
    CrossrefPubMedSearch in Google Scholar
  • 22 Ekbom A, Helmick C, Zack M. Ulcerative colitis and colorectal cancer: a population-based study.  N Engl J Med . 1990;  323 1228-1233
    CrossrefPubMedSearch in Google Scholar
  • 23 Rubin R, Friedman S, Harpaz N. Colonoscopic polypectomy in chronic colitis: conservative management after endoscopic resection of dysplastic polyps.  Gastroenterology . 1997;  117 1295-1300
    PubMedSearch in Google Scholar
  • 24 Winawer S, Fletcher R, Miller L. Colorectal cancer screening: clinical guidelines and rationale.  Gastroenterology . 1997;  112 594-642
    CrossrefPubMedSearch in Google Scholar
  • 25 Winawer S, Zauber A, Ho M. Prevention of colorectal cancer by colonoscopic polypectomy: The National Polyp Study Workgroup.  N Engl J Med . 1993;  329 1977-1981
    CrossrefPubMedSearch in Google Scholar
  • 26 Winawer S, Zauber A G, O'Brien M. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps.  N Engl J Med . 1993;  328 901-908
    CrossrefPubMedSearch in Google Scholar
  • 27 Beck D E, Opelka F G, Hicks T C, Timmcke A E, Khoury D G, Gathright J B. Colonoscopy follow-up of adenomas and colorectal cancer.  South Med J . 1995;  88 567-571
    PubMedSearch in Google Scholar
  • 28 Hixson L, Fennerty M, Sampliner R. Prospective study of the frequency and size distribution of polyps missed by colonoscopy.  J Natl Cancer Inst . 1990;  82 1769-1772
    CrossrefPubMedSearch in Google Scholar
  • 29 Cutler C, Clark D, Lehman G. The colonoscopic miss rate for neoplastic polyps-a prospective study of back-to-back colonoscopies.  Gastrointest Endosc . 1997;  41 376-381
    PubMedSearch in Google Scholar
  • 30 Ransohoff D, Lang C, Kuo H. Colonoscopic surveillance after polypectomy: considerations of cost effectiveness.  Ann Intern Med . 1991;  114 177-182
    CrossrefPubMedSearch in Google Scholar
  • 31 Buie W, Rothenberger D. Surveillance after curative resection of colorectal cancer: individualizing follow-up.  Gastrointest Endosc Clin N Am . 1993;  3 691-713
    PubMedSearch in Google Scholar
  • 32 Graham R, Wang S, Catalano P, Haller D. Postsurgical surveillance of colon cancer: preliminary cost analysis of physician examination, carcinoembryonic antigen testing, chest x-ray, and colonoscopy.  Ann Surg . 1998;  228 59-63
    CrossrefPubMedSearch in Google Scholar
  • 33 Bohm B, Schwenk W, Hucke H P. Does methodic long-term follow-up affect survival after curative resection of colorectal carcinoma?.  Dis Colon Rectum . 1993;  36 280-286
    PubMedSearch in Google Scholar
  • 34 Kievit J, van de Velde J H C. Utility and cost of carcinoembryonic antigen monitoring in colon cancer follow-up evaluation: a Markov analysis.  Cancer . 1990;  65 2580-2587
    PubMedSearch in Google Scholar
  • 35 Steele G. Follow-up plans after treatment of primary colon and rectum cancer.  World J Surg . 1991;  15 583-588
    CrossrefPubMedSearch in Google Scholar
  • 36 Chen F, Stuart M. Colonoscopic follow-up of colorectal carcinoma.  Dis Colon Rectum . 1994;  37 568-572
    PubMedSearch in Google Scholar
  • 37 Patchett S E, Mulcahy H E, O'Donoghue. Colonoscopic surveillance after curative resection for colorectal cancer.  Br J Surg . 1993;  80 1330-1332
    CrossrefPubMedSearch in Google Scholar
  • 38 Khory D, Beck D E, Opelka F G, Hicks T C, Timmcke A E, Gathright J B. Colonoscopy surveillance after colorectal cancer surgery.  Dis Colon Rectum . 1996;  39 252-256
    PubMedSearch in Google Scholar