The place and detection rates of colonoscopy within a faecal occult blood test-based screening program
Julius Špičák1, Petr Štirand1, Pavel Drastich1, Radim Bužga, Tomáš Hucl1, Pavel Wohl1, Jan Šperl1, Eva Honsová2, Radan Brůha3, Jaroslav Hnuta, Jiří Jungwirth4, Jan Kotrlík, Jana Koželuhová5, Milan Lukáš6, Vladimír Nosek7, Daniela Pulgretová, Marek Řehoř, Dalibor Šperl8, Petr Vyhnálek9, Marek Beneš1, Anna Jungwirthová10, Jaromír Petrtýl3
1 Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
2 Pracoviště klinické a transplantační patologie, Transplacentrum, IKEM, Praha
3 IV. interní klinika – klinika gastroenterologie a hepatologie 1. LF UK a VFN v Praze
4 Sanatorium u sv. Anny, Praha
5 Gastroenterologie, I. interní klinika LF UK a FN Plzeň
6 IBD clinical and research centre ISCARE a.s., Prague, Czech Republic
7 Gastroenterologie, Nemocnice Jablonec nad Nisou, p.o.
8 Poliklinika Mariánské Lázně
9 Interní oddělení, Pardubická nemocnice, Nemocnice Pardubického kraje, a. s.
10 Sanatorium sv. Anny, EGK s.r.o., Praha
Background, aim of the Study: Colorectal cancer is one of the most common cancers whose incidence is most likely to be reduced by screening. The aim of this prospective multicentre study was to review the detection rates of colorectal cancer and polyps and to assess the efficacy of colonoscopy and a screening program.
Results: A total of 3,827 consecutive colonoscopy procedures performed in 2005-2006 were assessed. Of these, 927 (24.2%) were scheduled on the basis of screening while 2,990 (75.8%) were based on the patien»s complaints. The most common symptom was faecal blood (32.5%) followed by abdominal pain (27.5%). In symptom-related colonoscopy procedures, the caecum was reached in 87.4% of cases (terminal ileum, in 36.3%) while, in screening-based ones, in 88.6% of cases (terminal ileum, in 45.6%). Twenty-four percent of examinations were performed without premedication. The rates of reaching the caecum varied between 75% and 98% with individual endoscopists. A total of 2,614 polyps were found in 1,169 patients (30.6%). Advanced adenomas were detected in 259 patients (6.8%), and carcinomas in 146 (3.8%). Among the polyps, 1,620 (62%) were pedunculated ones. Of the 1,081 histologies, 580 (53.6%) revealed tubular adenomas. A total of 212 (81.9%) significant adenomas and 106 (72.6%) carcinomas were localized in the left-side colon. The detection rates of large polyps by the 10 most active endoscopists were in the range of 7 to 20%, with the detection rates of all polyps varying between 28 and 145% depending on the number of colonoscopy procedures. A total of 485 patients having colonoscopy reported a family history. Of these, colonoscopy was indicated as a diagnostic procedure in 257 whereas 228 (47.0%) were scheduled for colonoscopy within the screening program. In the group of patients with a family history, advanced adenoma was present in 25 (5.1%), and carcinoma in 7 (1.4%). Of these 32 patients, 17(53%) were diagnosed as having advanced cancer by screening; their mean age was 47 years. The detection rates of cancer after positive and negative FOBTs were 8.1% and 2%, respectively; the rates with primary screening-based colonoscopy were 4.2%. Overall, screening detected 96 (37%) advanced adenomas and 52 (35.6%) carcinomas.
Conclusion: The ratio of screening-based colonoscopy procedures to those scheduled based on symptoms is about 1: 4. The guidelines recommending colonoscopy as a secondary screening procedure in patients with a positive FOBT are not strictly adhered to. The ratio of histologies to detected polyps is clearly inadequate. The low detection rates of screening in those with a family history can be explained by the patients1 significantly younger age. These individuals apparently undergo screening earlier, being aware as they are of the potential risks. Screening was successful in detecting a greater numbers of major lesions compared with the number of screening procedures actually performed.
Keywordscolorectal cancer, colonoscopy, screening, screening
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