Colonoscopy: Screening that really works!

In contrast to the results of other screening tests that don t seem to improve survival or early-stage disease progression (mammography and PSA, for example), a recent study reported in JAMA Surgery presents impressive data that colonoscopy does both.

Ramzi Amri and colleagues from the Massachusetts General Hospital and Harvard Medical School followed 1071 patients, 217 of whom were diagnosed with colon cancer through screening colonoscopy. They compared these patients to those whose colon cancer had not been detected via screening. The results were eye opening.

Compared to patients with colonoscopy-detected lesions, those with otherwise-detected cancer had a nearly 2-fold relative risk (RR) of a more invasive tumor and disease that had invaded the lymph nodes, an over 3-fold risk of disease that had already spread when they were first diagnosed, as well as a 3-fold higher death rate, a 2-fold higher rate of recurrent cancer, and shorter survival times. All these differences were highly statistically significant.

During a colonoscopic exam, the physician can remove precancerous polyps as well as cancerous lesions, thus preventing progression to cancer.

The authors reported Patients with colon cancer identified on screening colonoscopy not only have lower-stage disease on presentation but also have better outcomes independent of their staging.

People are often reluctant to follow the guidelines and undergo colonoscopy as recommended because of the unpleasant preparatory procedures, commented ACSH s Dr. Elizabeth Whelan. However, this study confirms the efficacy of this screening test. Colon cancer is the second leading cause of cancer-related death in the United States, and the American Cancer Society predicts that there will be over 100,000 new cases of colon cancer in the US this year, and nearly 51,000 deaths from the disease. Clearly, it pays to have colonoscopies as recommended.