https://www.medpagetoday.com/upload/2008/3/6/CRC.pdf

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.

https://louisville.edu/medicine/departments/medicine/divisions/gimedicine/physician-resources/lectures/gi-neoplasms/surveillance-colonoscopy

Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence

American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008

In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening

https://onlinelibrary.wiley.com/doi/pdf/10.3322/CA.2007.0018

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*†

Quality indicators for colonoscopy.

BACKGROUND Colorectal cancer is one of the leading causes of death from cancer in Western countries. Removal of adenomas is based on the assumption that it could lead to a reduction in the incidence of colorectal cancer, as demonstrated by the National Polyp Study in the USA. A critical issue is whether the benefit observed in clinical trials can also be observed in standard clinical practice. To address the issue, a multicentre Italian collaborative study was organised. METHODS The study cohort comprised 1693 subjects of both sexes, aged 40–69 years, enrolled between 1980 and 1987 following a total colon examination (TCE) (that is, total colonoscopy or colonoscopy and double contrast barium enema), with removal of at least one adenoma larger than 5 mm in diameter. Exclusion criteria were genetic syndromes, previous adenomas or colorectal cancer, previous colonic resection, inflammatory bowel disease, or sessile adenomas more than 3 cm in diameter. Follow up ended in December 1996 by TCE or telephone interview, and review of the medical records, clinical files, or death certificates. Incidence ratios for colorectal cancer were compared with expected age and sex specific incidences in the Italian general population. RESULTS Follow up data were obtained for 97.3% of cases for a total of 14 211 person/years. Mean follow up was 10.5 years. Six colorectal cancer cases (four in males, two in females) at various stages were ascertained (one at 29 months, two at five years, one at seven years, one at eight years, and one at 10 years from the index examination). The number of cancers expected in the reference population was 17.7 for an incidence ratio of 0.34 (confidence interval 0.23–0.63; p CONCLUSIONS Colonoscopic polypectomy substantially reduced the incidence of colorectal cancer in the cohort compared with that expected in the general population. These results are of particular relevance considering that those with adenomas are at increased risk of colorectal cancer and that this retrospective study was performed on data obtained in standard clinical practice. This observation strengthens the concept of effective population screening in view of the fact that adenomatous polyps are the most frequent neoplastic outcome of screening and their removal is associated with a decrease in the incidence of colorectal cancer.

https://gut.bmj.com/content/gutjnl/48/6/812.full.pdf

Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence

Several unresolved issues still cast doubts on the epidemiological data which point to an association between infection from Helicobacter pylori (Hp) and gastric cancer. These are: a) the male/female ratio of gastric cancer ranges from 4 to 1.5 in all studies, whereas the prevalence of Hp infection is the same in both sexes; b) the prevalence of Hp infection is as high as 90% in several developing countries where the frequency of gastric cancer is very low; c) the acquisition of the infection at a young age, considered very important with regard to the risk for cancer, varies from 4.2% to 83% in several countries in which the mortality for stomach cancer is, on the average, 10/100,000; d) the incidence of cancer in patients with a duodenal ulcer is half of that of the general population but Hp infects up to 100% of these patients. In the sequence of events that lead to gastric cancer, Hp appears to play a role only in the very initial steps, as a causative agent of chronic inflammation. The further events which lead to cancer are multifactorial, involving environmental agents and the host response. It is therefore inappropriate to consider Hp a direct carcinogen for humans. This also applies to specific strains of the bacterium such as the ones expressing the cagA gene. In a study we conducted in an area with a low incidence of gastric cancer (Latina), the prevalence of Hp infection was equal to 78.6% and, among the positives, 81% resulted cagA positive. This data, if compared with a similar research that took place in another area with a high incidence of gastric cancer (San Marino) where the prevalence of Hp infection was 51% and cagA 69%, further demonstrates the inconsistency of associating Hp and cancer of the stomach.

G. Tomaselli

Papers

Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence

Helicobacter pylori and gastric cancer