Guidelines for colonoscopy surveillance after polypectomy: A consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society
Sidney J. Winawer,Ann G. Zauber,Robert H. Fletcher,Jonathon S. Stillman,Michael J. O'Brien,Bernard Levin,Robert A. Smith,David Lieberman,Randall W. Burt,Theodore R. Levin,John H. Bond,Durado Brooks,Tim Byers,Neil Hyman,Lynne M. Kirk,Alan G. Thorson,Clifford Simmang,David W. Johnson,Douglas K. Rex +18 more
TLDR
A careful analytic approach was designed addressing all evidence available in the literature to delineate predictors of advanced pathology, both cancer and advanced adenomas, so that patients can be more definitely stratified at their baseline colonoscopy into those at lower or increased risk for a subsequent advanced neoplasia.Abstract:
Adenomatous polyps are the most common neoplastic findings uncovered in people who undergo colorectal screening or have a diagnostic workup for symptoms. It was common practice in the 1970s for these patients to have annual follow-up surveillance examinations to detect additional new adenomas as well as missed synchronous adenomas. As a result of the National Polyp Study report in 1993, which demonstrated clearly in a randomized design that the first postpolypectomy examination could be deferred for 3 years, guidelines published by a gastrointestinal consortium in 1997 recommended that the first follow-up surveillance be 3 years after polypectomy for most patients. In 2003, these guidelines were updated, colonoscopy was recommended as the only follow-up examination, and stratification at baseline into lower and higher risk for subsequent adenomas was suggested. The 1997 and 2003 guidelines dealt with both screening and surveillance. However, it has become increasingly clear that postpolypectomy surveillance is now a large part of endoscopic practice, draining resources from screening and diagnosis. In addition, surveys have demonstrated that a large proportion of endoscopists are conducting surveillance examinations at shorter intervals than recommended in the guidelines. In the present paper, a careful analytic approach was designed addressing all evidence available in the literature to delineate predictors of advanced pathology, both cancer and advanced adenomas, so that patients can be more definitely stratified at their baseline colonoscopy into those at lower or increased risk for a subsequent advanced neoplasia. People at increased risk have either three or more adenomas, or high-grade dysplasia, or villous features, or an adenoma ≥1 cm in size. It is recommended that they have a 3-year follow-up colonoscopy. People at lower risk who have one or two small (<1 cm) tubular adenomas with no high-grade dysplasia can have a follow up in 5 to 10 years, whereas people with hyperplastic polyps only should have a 10-year follow up as average-risk people. Recent papers have reported a significant number of missed cancers by colonoscopy. However, high-quality baseline colonoscopy with excellent patient preparation and adequate withdrawal time should minimize this and reduce clinicians' concerns. These guidelines were developed jointly by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society to provide a broader consensus and thereby increase utilization of the recommendations by endoscopists. Adoption of these guidelines nationally can have a dramatic impact on shifting available resources from intensive surveillance to screening. It has been shown that the first screening colonoscopy and polypectomy produces the greatest effects on reducing the incidence of colorectal cancer in patients with adenomatous polyps.read more
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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.
Bernard Levin,David A. Lieberman,Beth McFarland,Kimberly S. Andrews,Durado Brooks,John H. Bond,Chiranjeev Dash,Francis M. Giardiello,Seth N. Glick,David W. Johnson,C. Daniel Johnson,Theodore R. Levin,Perry J. Pickhardt,Douglas K. Rex,Robert A. Smith,Alan G. Thorson,Sidney J. Winawer +16 more
TL;DR: Clinicians 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 those that can detect cancer early and also can detect adenomatous polyps.
Journal ArticleDOI
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
Brenda K. Edwards,Elizabeth Ward,Betsy A. Kohler,Christie R. Eheman,Ann G. Zauber,Robert N. Anderson,Ahmedin Jemal,Maria J. Schymura,Iris Lansdorp-Vogelaar,Laura C. Seeff,Marjolein van Ballegooijen,S. Luuk Goede,Lynn A. G. Ries +12 more
TL;DR: This year's report includes trends in colorectal cancer incidence and death rates and highlights the use of microsimulation modeling as a tool for interpreting past trends and projecting future trends to assist in cancer control planning and policy decisions.
Journal ArticleDOI
Quality Indicators for Colonoscopy and the Risk of Interval Cancer
Michal F. Kaminski,Jaroslaw Regula,Ewa Kraszewska,Marcin Polkowski,Urszula Wojciechowska,Joanna Didkowska,Maria Zwierko,Maciej Rupinski,M. Nowacki,Eugeniusz Butruk +9 more
TL;DR: The adenoma detection rate is an independent predictor of the risk of interval colorectal cancer after screening colonoscopy, and the rate of cecal intubation was not significantly associated with this risk.
Journal ArticleDOI
Role of the serrated pathway in colorectal cancer pathogenesis.
TL;DR: The recognition of this pathway during the last 15 years has led to a paradigm shift in understanding of the molecular basis of colorectal cancer and significant changes in clinical practice, and these findings are particularly relevant to prevention of interval cancers through colonoscopy surveillance programs.
Journal ArticleDOI
Cancer screening in the United States, 2010: a review of current American Cancer Society guidelines and issues in cancer screening.
TL;DR: The current ACS guidelines and recent issues are summarized, updates of guidelines for testing for early breast cancer detection by the US Preventive Services Task Force and for prevention and early detection of cervical cancer from the American College of Obstetricians and Gynecologists are addressed, and the most recent data from the National Health Interview Survey pertaining to participation rates in cancer screening are described.
References
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Journal ArticleDOI
Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup.
Sidney J. Winawer,A G Zauber,M N Ho,Michael J. O'Brien,Leonard S. Gottlieb,S S Sternberg,Jerome D. Waye,Melvin Schapiro,John H. Bond,Joel F. Panish +9 more
TL;DR: The results of the National Polyp Study support the view that colorectal adenomas progress to adenocarcinomas, as well as the current practice of searching for and removing adenomatous polyps to prevent coloreCTal cancer.
Journal ArticleDOI
Reducing Mortality from Colorectal Cancer by Screening for Fecal Occult Blood
Jack S. Mandel,John H. Bond,Timothy R. Church,Dale C. Snover,Bradley Gm,Leonard M. Schuman,Fred Ederer +6 more
TL;DR: Cutting mortality in the annually screened group was accompanied by improved survival in those with colorectal cancer and a shift to detection at an earlier stage of cancer.
Journal ArticleDOI
Revised Bethesda Guidelines for Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome) and Microsatellite Instability
Asad Umar,C. Richard Boland,Jonathan P. Terdiman,Sapna Syngal,Albert de la Chapelle,Josef Rüschoff,Richard Fishel,Noralane M. Lindor,Lawrence J. Burgart,Richard Hamelin,Stanley R. Hamilton,Robert A. Hiatt,Jeremy R. Jass,Annika Lindblom,Henry T. Lynch,Päivi Peltomäki,Scott D. Ramsey,Miguel A. Rodriguez-Bigas,Hans F. A. Vasen,Ernest T. Hawk,J. Carl Barrett,Andrew N. Freedman,Sudhir Srivastava +22 more
TL;DR: This commentary summarizes the Workshop presentations on HNPCC and MSI testing; presents the issues relating to the performance, specificity, and specificity of the Bethesda Guidelines; outlines the revised Bethesda Guidelines for identifying individuals at risk for H NPCC; and recommend criteria for MSI testing.
Journal ArticleDOI
Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence
Sidney J. Winawer,Robert H. Fletcher,Douglas K. Rex,John H. Bond,Randall W. Burt,Joseph T. Ferrucci,Theodore G. Ganiats,Theodore R. Levin,Steven H. Woolf,David W. Johnson,Lynne M. Kirk,Scott C. Litin,Clifford Simmang +12 more
TL;DR: These guidelines differ from those published in 1997 in several ways: the screening interval for double contrast barium enema has been shortened to 5 years, and colonoscopy is the preferred test for the diagnostic investigation of patients with findings on screening and for screening patients with a family history of hereditary nonpolyposis colorectal cancer.
Journal ArticleDOI
Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults.
Perry J. Pickhardt,J. Richard Choi,Inku Hwang,James A. Butler,Michael L. Puckett,Hans A. Hildebrandt,Roy K.H. Wong,Pamela A. Nugent,Pauline A. Mysliwiec,William R. Schindler +9 more
TL;DR: CT virtual colonoscopy with the use of a three-dimensional approach is an accurate screening method for the detection of colorectal neoplasia in asymptomatic average-risk adults and compares favorably with optical Colonoscopy in terms of the Detection of clinically relevant lesions.