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.

BACKGROUND In the National Polyp Study (NPS), colorectal cancer was prevented by colonoscopic removal of adenomatous polyps. We evaluated the long-term effect of colonoscopic polypectomy in a study on mortality from colorectal cancer. METHODS We included in this analysis all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death; follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with nonadenomatous polyps (internal control group). RESULTS Among 2602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 (95% confidence interval [CI], 0.26 to 0.80) with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2; 95% CI, 0.1 to 10.6). CONCLUSIONS These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.)

/pdf/colonoscopic-polypectomy-and-long-term-prevention-of-26sw5itn6w.pdf

Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths

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

https://www.gastrojournal.org/article/S0016-5085(97)00049-8/pdf

Colorectal cancer screening: Clinical guidelines and rationale

Background and Methods The role of colonoscopy in screening for colorectal cancer is uncertain. At 13 Veterans Affairs medical centers, we performed colonoscopy to determine the prevalence and location of advanced colonic neoplasms and the risk of advanced proximal neoplasia in asymptomatic patients (age range, 50 to 75 years) with or without distal neoplasia. Advanced colonic neoplasia was defined as an adenoma that was 10 mm or more in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. In patients with more than one neoplastic lesion, classification was based on the most advanced lesion. Results Of 17,732 patients screened for enrollment, 3196 were enrolled; 3121 of the enrolled patients (97.7 percent) underwent complete examination of the colon. The mean age of the patients was 62.9 years, and 96.8 percent were men. Colonoscopic examination showed one or more neoplastic lesions in 37.5 percent of the patients, an adenoma with a diameter of at least 10 mm or a villous...

https://www.nejm.org/doi/pdf/10.1056/NEJM200007203430301

Use of Colonoscopy to Screen Asymptomatic Adults for Colorectal Cancer

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(96)03386-7.pdf

Randomised controlled trial of faecal-occult-blood screening for colorectal cancer

Objective
The approach to acute cognitive dysfunction varies among physicians, including intensivists. Physicians may differ in their labeling of cognitive abnormalities in critically ill patients. We aimed to survey: (a) what Canadian intensive care unit (ICU) physicians identify as “delirium”; (b) choices of non-pharmacological and pharmacological management; and (c) consultation patterns among ICU patients with cognitive abnormalities.

Recognition and labeling of delirium symptoms by intensivists: does it matter?

A study was carried out to investigate the change in stage at presentation of patients with colorectal cancer over 10 years. Cases were identified from the control group of subjects enrolled into a randomized controlled study based on Haemoccult screening for colorectal neoplasia. Of 405 subjects in the control group (presenting with symptomatic colorectal cancer, 206 presented before 1989 and 199 since then. The number of patients with Dukes' stage A carcinoma diagnosed since 1989 rose from 21 (10.4 per cent) to 35 (18.1 per cent); this change occurred for rectosigmoid tumours (9.9 per cent before 1989, 28 per cent after 1989) but not for colonic cancer (10.9 per cent before 1989, 11.5 per cent thereafter). An increase in the proportion of patients with symptomatic early-stage rectosigmoid cancer has been observed in the past 10 years. No such change occurred in those with colonic cancer. This may reflect a change in awareness of te disease and its symptoms by patients and general practitioners.

Change towards earlier stage at presentation of colorectal cancer.

HOMOGRAFT REPLACEMENT OF THE AORTIC VALVE: Immediate Results and Follow-up

Fecal α1-antitrypsin measurement may be of value for the detection of coloreactal neoplasia and is compared with the HemoQuant test in 119 subjects with either a screen-positive Hemoccult result (N=78) or iron-deficiency anaemia (N=41). Nineteen patients were found to have coloreactal cancer, 35 had colorectal adenomatous polyps, 5 had inflammatory bowel disease, and 60 had no detected cause of occult blood loss. Of the cancer patients, 63% (12/19) were detected by fecal α1-antitrypsin, and 63% (12/19) by HemoQuant. Of the adenomas >1 cm in diameter 33% (7/23) were detected by fecal α1-antitrypsin and 26% (6/23) by HemoQuant. There was a poor correlation between fecal α1-antitrypsin, and HemoQuant results for colorectal cancers (r=0.37,P>0.05), and combining the tests, the sensitivity for colorectal cancer was incerased to 84% (16/19). Fecal proteins loss, as measured using α1-antitrypsin, appears to involve largely different mechanisms from that of blood loss from colorectal cancers.

Michael Robinson

Papers

Randomised controlled trial of faecal-occult-blood screening for colorectal cancer

Recognition and labeling of delirium symptoms by intensivists: does it matter?

Change towards earlier stage at presentation of colorectal cancer.

HOMOGRAFT REPLACEMENT OF THE AORTIC VALVE: Immediate Results and Follow-up

Fecal α1-antitrypsin detection of colorectal neoplasia : an evaluation using HemoQuant