Skip to main content
SpringerLink
Log in

Screening for Colorectal Cancer Using Colonoscopy

  • Chapter
  • First Online:
Colorectal Cancer Screening

Part of the book series: Clinical Gastroenterology ((CG))

  • 1100 Accesses

Abstract

The first study to clearly demonstrate the efficacy of colorectal cancer screening was a case-control study published in 1992, which found a 60% reduction in distal colorectal cancer mortality associated with sigmoidoscopy [1]. Subsequently, casecontrol studies at the Marshfield Clinic in Wisconsin [2] and in Washington State [3] demonstrated that flexible sigmoidoscopy was associated with an 80% reduction in distal colorectal cancer incidence. In addition, evaluation of a randomized controlled trial of fecal occult blood testing demonstrated that fecal occult blood testing had resulted in not only a reduction in colorectal cancer mortality but also in a 20% reduction in incidence of colorectal cancer [4]. The latter appeared related to identification of large colorectal polyps by fecal occult blood testing and their subsequent removal by colonoscopy and polypectomy. In 1993, evaluation of an adenoma cohort participating in the National Polyp Study reported that colonoscopy and polypectomy was associated with a 76–90% reduction in the incidence of colorectal cancer by comparison of incident cancer rates in the adenoma cohort compared to expected rates in three reference populations [5].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Selby JV, Friedman GD, Quesenberry Jr CP, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653–7.

    Article  PubMed  CAS  Google Scholar 

  2. Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst. 1992;84:1572–5.

    Article  PubMed  CAS  Google Scholar 

  3. Newcomb PA, Storer BE, Morimoto LM, Templeton A, Potter JD. Long-term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidence. J Natl Cancer Inst. 2003;95:622–5.

    Article  PubMed  Google Scholar 

  4. Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med. 2000;343:1603–7.

    Article  PubMed  CAS  Google Scholar 

  5. Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–81.

    Article  PubMed  CAS  Google Scholar 

  6. Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–95.

    Article  PubMed  CAS  Google Scholar 

  7. Rex D, Sledge G, Harper P, Ulbright T, Loehrer P, Helper D, et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol. 1993;88:825–31.

    PubMed  CAS  Google Scholar 

  8. Rogge JD, Elmore MF, Mahoney SJ, Brown ED, Troiano FP, Wagner DR, et al. Low-cost, office-based, screening colonoscopy. Am J Gastroenterol. 1994;89:1775–80.

    PubMed  CAS  Google Scholar 

  9. Imperiale T, Wagner D, Lin C, Larkin G, Rogge J, Ransohoff D. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000;343:169–74.

    Article  PubMed  CAS  Google Scholar 

  10. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med. 2000;343:162–8.

    Article  PubMed  CAS  Google Scholar 

  11. Podolsky DK. Going the distance – the case for true colorectal-cancer screening. N Engl J Med. 2000;343:207–8.

    Article  PubMed  CAS  Google Scholar 

  12. Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328:1365–71.

    Article  PubMed  CAS  Google Scholar 

  13. Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–71.

    Article  PubMed  CAS  Google Scholar 

  14. Hardcastle JD, Chamberlain JO, Robinson MHE, Moss SM, Amar SS, Balfour TW, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–7.

    Article  PubMed  CAS  Google Scholar 

  15. Winawer S, Fletcher R, Miller L, Godlee F, Stolar M, Mulrow C, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology. 1997;112:594–642.

    Article  PubMed  CAS  Google Scholar 

  16. Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355:2533–41.

    Article  PubMed  CAS  Google Scholar 

  17. Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol. 2007;102:856–61.

    Article  PubMed  Google Scholar 

  18. Imperiale TF, Glowinski EA, Juliar BE, Azzouz F, Ransohoff DF. Variation in polyp detection rates at screening colonoscopy. Gastrointest Endosc. 2009;69:1288–95.

    Article  PubMed  Google Scholar 

  19. Rex DK, Helbig CC. High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging. Gastroenterology. 2007;133:42–7.

    Article  PubMed  Google Scholar 

  20. Kahi C, Anderson JC, Waxman I, Kessler WR, Imperiale TF, Li X, et al. High-definition chromocolonoscopy versus high-definition white light colonoscopy for average-risk colorectal cancer screening. Am J Gastroenterol. 2010;105:1301–7.

    Google Scholar 

  21. Rex DK, Petrini JL, Baron TH, Chak A, Cohen J, Deal SE, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2006;63:S16–28.

    Article  PubMed  Google Scholar 

  22. Rex DK, Bond JH, Winawer S, Levin TR, Burt RW, Johnson DA, et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2002;97:1296–308.

    Article  PubMed  Google Scholar 

  23. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol. 2009;104:739–50.

    Article  PubMed  Google Scholar 

  24. Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150:1–8.

    PubMed  Google Scholar 

  25. Brenner H, Hoffmeister M, Arndt V, Stegmaier C, Altenhofen L, Haug U. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst. 2010;102:89–95.

    Article  PubMed  Google Scholar 

  26. Singh G, Gerson LB, Wang H, Nannalithara A, Mithal A, Graham DJ, et al. Screening colonoscopy, colorectal cancer and gender: an unfair deal for the fair sex? Gastrointest Endosc. 2007;65:AB100.

    Google Scholar 

  27. Singh H, Nugent Z, Mahmud SM, Demers AA, Bernstein CN. Predictors of colorectal cancer after negative colonoscopy: a population-based study. Am J Gastroenterol. 2010;105:663–73.

    Article  PubMed  Google Scholar 

  28. Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M, The Italian Multicentre Study Group. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing ­colorectal cancer incidence. Gut. 2001;48:812–5.

    Article  PubMed  CAS  Google Scholar 

  29. Thiis-Evensen E, Hoff G, Sauar J, Langmark F, Majak B, Vatn M. Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scand J Gastroenterol. 1999;34:414–20.

    Article  PubMed  CAS  Google Scholar 

  30. Muller AD, Sonnenberg A. Prevention of colorectal cancer by flexible endoscopy and polypectomy. A case-control study of 32,702 veterans. Ann Intern Med. 1995;123:904–10.

    PubMed  CAS  Google Scholar 

  31. Brenner H, Chang-Claude J, Seiler CM, Sturmer T, Hoffmeister M. Does a negative screening colonoscopy ever need to be repeated? Gut. 2006;55:1145–50.

    Article  PubMed  CAS  Google Scholar 

  32. Gross CP, Andersen MS, Krumholz HM, McAvay GJ, Proctor D, Tinetti ME. Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer. JAMA. 2006;296:2815–22.

    Article  PubMed  Google Scholar 

  33. Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–73.

    Article  PubMed  Google Scholar 

  34. Robertson DJ, Greenberg ER, Beach M, Sandler RS, Ahnen D, Haile RW, et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology. 2005;129:34–41.

    Article  PubMed  Google Scholar 

  35. Alberts DS, Martinez ME, Roe DJ, Guillen-Rodriguez JM, Marshall JR, van Leeuwen JB, et al. Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. Phoenix Colon Cancer Prevention Physicians’ Network. N Engl J Med. 2000;342:1156–62.

    Article  PubMed  CAS  Google Scholar 

  36. Schatzkin A, Lanza E, Corle D, Lance P, Iber F, Caan B, et al. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. Polyp Prevention Trial Study Group. N Engl J Med. 2000;342:1149–55.

    Article  PubMed  CAS  Google Scholar 

  37. Hewett DG, Kahi CJ, Rex DK. Does colonoscopy work? J Natl Compr Canc Netw. 2010;8:67–76. quiz 77.

    PubMed  Google Scholar 

  38. Kahi CJ, Imperiale TF, Juliar BE, Rex DK. Effect of screening colonoscopy on colorectal cancer incidence and mortality. Clin Gastroenterol Hepatol. 2009;7:770–5.

    Article  PubMed  Google Scholar 

  39. Arain MA, Sawhney M, Sheikh S, Anway R, Thyagarajan B, Bond JH, et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol. 2010;105(5):1189–95.

    Article  PubMed  Google Scholar 

  40. Singh H, Nugent Z, Demers AA, Kliwer EV, Mahmud SM, Bernstein CN. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterol. 2010;139:1128–37.

    Article  PubMed  Google Scholar 

  41. Baxter N, Sutradhar R, Forbes DD, Paszat LF, Saskin R, Rabeneck L. Analysis of administrative data finds endoscopist quality measures asociated with post-colonoscopy colorectal cancer. Gastroenterol. 2011;140:65–72.

    Article  PubMed  Google Scholar 

  42. Brenner H, Chang-Claude J, Seiler CM, Rickert A, Hoffmeister M. Protection from colorectal cancer after colonoscopy: a population-based, case-control study. Ann Intern Med 2011;154:22–30.

    Article  PubMed  Google Scholar 

  43. Rostom A, Jolicoeur E, Dube C, Gregoire S, Patel D, Saloojee N, et al. A randomized prospective trial comparing different regimens of oral sodium phosphate and polyethylene glycol-based lavage solution in the preparation of patients for colonoscopy. Gastrointest Endosc. 2006;64:544–52.

    Article  PubMed  Google Scholar 

  44. Aoun E, Abdul-Baki H, Azar C, Mourad F, Barada K, Berro Z, et al. A randomized single-blind trial of split-dose PEG-electrolyte solution without dietary restriction compared with whole dose PEG-electrolyte solution with dietary restriction for colonoscopy preparation. Gastrointest Endosc. 2005;62:213–8.

    Article  PubMed  Google Scholar 

  45. Park JS, Sohn CI, Hwang SJ, Choi HS, Park JH, Kim HJ, et al. Quality and effect of single dose versus split dose of polyethylene glycol bowel preparation for early-morning colonoscopy. Endoscopy. 2007;39:616–9.

    Article  PubMed  CAS  Google Scholar 

  46. Church JM. Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy – timing is the key! Dis Colon Rectum. 1998;41:1223–5.

    Article  PubMed  CAS  Google Scholar 

  47. El Sayed AM, Kanafani ZA, Mourad FH, Soweid AM, Barada KA, Adorian CS, et al. A randomized single-blind trial of whole versus split-dose polyethylene glycol-electrolyte solution for colonoscopy preparation. Gastrointest Endosc. 2003;58:36–40.

    Article  PubMed  Google Scholar 

  48. Frommer D. Cleansing ability and tolerance of three bowel preparations for colonoscopy. Dis Colon Rectum. 1997;40:100–4.

    Article  PubMed  CAS  Google Scholar 

  49. Abdul-Baki H, Hashash JG, Elhajj II, Azar C, El Zahabi L, Mourad FH, et al. A randomized, controlled, double-blind trial of the adjunct use of tegaserod in whole-dose or split-dose polyethylene glycol electrolyte solution for colonoscopy preparation. Gastrointest Endosc. 2008;68:294–300.

    Article  PubMed  Google Scholar 

  50. Chiu HM, Lin JT, Wang HP, Lee YC, Wu MS. The impact of colon preparation timing on colonoscopic detection of colorectal neoplasms – a prospective endoscopist-blinded randomized trial. Am J Gastroenterol. 2006;101:2719–25.

    Article  PubMed  Google Scholar 

  51. Gupta T, Mandot A, Desai D, Abraham P, Joshi A, Shah S. Comparison of two schedules (previous evening versus same morning) of bowel preparation for colonoscopy. Endoscopy. 2007;39:706–9.

    Article  PubMed  CAS  Google Scholar 

  52. Parra-Blanco A, Nicolas-Perez D, Gimeno-Garcia A, Grosso B, Jimenez A, Ortega J, et al. The timing of bowel preparation before colonoscopy determines the quality of cleansing, and is a significant factor contributing to the detection of flat lesions: a randomized study. World J Gastroenterol. 2006;12:6161–6.

    PubMed  Google Scholar 

  53. DiPalma JA, Rodriguez R, McGowan J, Cleveland MB. A randomized clinical study evaluating the safety and efficacy of a new, reduced-volume, oral sulfate colon-cleansing preparation for colonoscopy. Am J Gastroenterol. 2009;104:2275–84.

    Article  CAS  Google Scholar 

  54. Unger RZ, Amstutz SP, Seo DA, Huffman M, Rex DK. Willingness to undergo split-dose bowel preparation for colonoscopy and compliance with split-dose instructions. Dig Dis Sci. 2010;55(7):2030–4.

    Article  PubMed  Google Scholar 

  55. American Society of Anesthesiologists practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology. 1999;90:896–905.

    Google Scholar 

  56. Rex DK. Maximizing detection of adenomas and cancers during colonoscopy. Am J Gastroenterol. 2006;101:2866–77.

    Article  PubMed  Google Scholar 

  57. Spring KJ, Zhao ZZ, Karamatic R, Walsh MD, Whitehall VL, Pike T, et al. High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology. 2006;131:1400–7.

    Article  PubMed  CAS  Google Scholar 

  58. Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O’Brien MJ, Levin B, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872–85.

    Article  PubMed  Google Scholar 

  59. Khalid O, Radaideh S, Cummings OW, O’Brien MJ, Goldblum JR, Rex DK. Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001. World J Gastroenterol. 2009;15:3767–70.

    Article  PubMed  Google Scholar 

  60. Rex DK, Ulbright TM. Step section histology of proximal colon polyps that appear hyperplastic by endoscopy. Am J Gastroenterol. 2002;97:1530–4.

    Article  PubMed  Google Scholar 

  61. Anderson JC, Pollack BJ. Predicting of hyperplastic histology by endoscopic features. Gastrointest Endosc. 2000;52:149–50.

    PubMed  CAS  Google Scholar 

  62. Jaramillo E, Watanabe M, Slezak P, Rubio C. Flat neoplastic lesions of the colon and rectum detected by high-resolution video endoscopy and chromoscopy. Gastrointest Endosc. 1995;42:114–22.

    Article  PubMed  CAS  Google Scholar 

  63. Tsuda S, Veress B, Toth E, Fork F. Flat and depressed colorectal tumours in southern Swedish population: a prospective chromoendoscopic and histopathological study. Gut. 2002;51:550–5.

    Article  PubMed  CAS  Google Scholar 

  64. Hurlstone D, Cross S, Adam I, Shorthouse A, Brown S, Sanders D, et al. A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom. Am J Gastroenterol. 2003;98:2543–9.

    Article  PubMed  Google Scholar 

  65. Rembacken B, Fujii T, Cairns A, Dixon M, Yoshida S, Chalmers D, et al. Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet. 2000;355:1211–4.

    Article  PubMed  CAS  Google Scholar 

  66. Kudo S, Lambert R, Allen JI, Fujii H, Fujii T, Kashida H, et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc. 2008;68(4 Suppl):S3–47.

    Article  PubMed  Google Scholar 

  67. Soetikno RM, Kaltenbach T, Rouse RV, Park W, Maheshwari A, Sato T, et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA. 2008;299:1027–35.

    Article  PubMed  CAS  Google Scholar 

  68. Brooker J, Saunders B, Shah S, Thapar CJ, Thomas HJ, Atkin WS, et al. Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial. Gastrointest Endosc. 2002;56:333–8.

    Article  PubMed  Google Scholar 

  69. Hurlstone DP, Cross SS, Slater R, Sanders DS, Brown S. Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy. Gut. 2004;53:376–80.

    Article  PubMed  CAS  Google Scholar 

  70. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58(6 Suppl):S3–43.

    Google Scholar 

  71. Khashab M, Eid E, Rusche M, Rex DK. Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc. 2009;70:344–9.

    Article  PubMed  Google Scholar 

  72. Mattar W, Rex DK. Large sessile adenomas are associated with a high prevalence of synchronous advanced adenomas. Clin Gastroenterol Hepatol. 2008;6:877–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indiana University Hospital, #4100, 550 North University Boulevard, Indianapolis, IN, 46202, USA

    Douglas K. Rex

Authors
  1. Douglas K. Rex
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Douglas K. Rex .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology, University of Connecticut, 263 Farmington Avenue, Farmington, 06030, USA

    Joseph Anderson, MD

  2. Indiana University School of Medicine, 1481 W 10th street, 111G, Indianapolis, 46202, USA

    Charles Kahi, MD

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Rex, D.K. (2011). Screening for Colorectal Cancer Using Colonoscopy. In: Anderson, MD, J., Kahi, MD, C. (eds) Colorectal Cancer Screening. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-60761-398-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-398-5_6

  • Published:

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60761-397-8

  • Online ISBN: 978-1-60761-398-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation