Incidental Finding of Colorectal Cancer in Screening Colonoscopy and Its Cost Effectiveness

2009 ◽  
Vol 75 (8) ◽  
pp. 699-704 ◽  
Author(s):  
Chichi Berhane ◽  
David Denning
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Villous Adenoma ◽  
Colorectal Neoplasm ◽  
Incidental Finding ◽  
Screening Colonoscopy ◽  
Tubular Adenoma ◽  
Hyperplastic Polyps ◽  
Asymptomatic Patients ◽  
Involvement Rate

The objective of this study is to measure the risk of colorectal cancer and adenoma with screening colonoscopy and its cost effectiveness. We reviewed the procedure and pathology results of approximately 11,000 asymptomatic patients age 50 to 90 that underwent screening colonoscopy Among those 11,808 screening colonoscopies performed, advance neoplasm (adenocarcinoma) was detected in 272 (2.3%) patients; age 50 to 90, with mean age of 64-years-old. Fourteen per cent had hyperplastic polyps, 15 per cent had tubular adenoma, and 8.6 per cent villous adenoma. Adenoma with high grade dysplasia was found in 6.6 per cent, and 5.5 per cent had nonadenomatous lesions. Sixty-five of 272 (24%) neoplasms were found proximally Forty-five of 207 distal neoplasms were found through sigmoidoscopy, nine of 45 (20%) had proximal involvement. Rate of complication during colonoscopy was 0.06 per cent and no patients died. All patients underwent complete colonoscopy, 99.8 per cent were men. Rate of adenocarcinoma from 2000 to 2006 was (24/470, 29/520, 33/891,37/961,46/2889,49/2977, and 54/3100). Screening colonoscopy can detect advanced colorectal neoplasm in asymptomatic adults. The more screening colonoscopy was preformed the earlier the neoplasm was discovered and with better prognosis. Twenty per cent of the patients with distal neoplasms found on sigmoidoscopy had proximal lesions when complete colonoscopies were performed. These findings warrant refinement of the screening recommendations for colorectal cancer.

Costs and Cost-Effectiveness of a Low-Intensity Patient-Directed Intervention to Promote Colorectal Cancer Screening

2007 ◽  
Vol 25 (33) ◽  
pp. 5248-5253 ◽  
Author(s):  
Veena Shankaran ◽  
June M. McKoy ◽  
Neal Dandade ◽  
Narissa Nonzee ◽  
Cara A. Tigue ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Incremental Cost ◽  
Incremental Cost Effectiveness Ratio ◽  
Screening Colonoscopy ◽  
Cost Effectiveness Ratio ◽  
Crc Screening ◽  
Low Intensity ◽  
The Cost

Purpose Colorectal cancer (CRC) screening is the most underused evidence-based cancer screening test in the United States. Few studies have reported the cost-effectiveness of CRC screening promotional efforts. In a recent randomized controlled trial, a patient-directed intervention for average-risk patients who had been referred for screening colonoscopy led to a 12% increase in CRC screening rates. The objective of this secondary analysis is to assess the cost-effectiveness of this intervention. Patients and Methods Patients in the intervention arm received a customized mailed brochure that included a reminder to schedule a screening colonoscopy and general information about CRC, the importance of CRC screening, and how to prepare for the procedure. The end point was completion of screening colonoscopy. The costs and incremental cost-effectiveness ratio of this patient-directed intervention were derived. Sensitivity analyses were based on varying the costs of labor and supplies. Results Rates of CRC screening for the intervention (n = 386 patients) versus control (n = 395) arms were 71% and 59%, respectively (P = .001). The total cost of the intervention was $1,927 and the incremental cost-effectiveness ratio was $43 per additional patient screened ($38 to $47 in a sensitivity analysis). Conclusion An intervention based on mailing a customized brochure to patients who were referred for a screening colonoscopy improved CRC screening rates at a university-based general medicine clinic. This intervention was comparable in effectiveness and cost-effectiveness to a similar recently reported low-intensity patient-directed CRC screening intervention, and markedly more affordable and cost-effective than a previously reported physician-directed CRC screening promotion intervention.

scholarly journals Pneumatosis Coli Mimicking Colorectal Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Teresa Jacob ◽  
Mohammad Paracha ◽  
Marta Penna ◽  
Dhili Arul ◽  
Jonathan Wilson
Keyword(s):  
Colorectal Cancer ◽  
Surgical Management ◽  
Incidental Finding ◽  
Rare Condition ◽  
Resected Specimen ◽  
Pneumatosis Coli ◽  
Benign Condition ◽  
Asymptomatic Patients ◽  
Successful Recovery ◽  
Emergency Surgical Intervention

Pneumatosis coli (PC) is a rare condition of the gastrointestinal tract involving extraluminal gas confined within the bowel wall. We report the case of a 40-year-old gentleman presenting clinically and endoscopically with suspected colorectal cancer. In light of the patient’s red flag symptoms, and carpet of polyps seen endoscopically, surgical management by an anterior resection was performed with the patient making a successful recovery. Histological analysis of the resected specimen confirmed pneumatosis coli with no evidence of colonic neoplasia. Although PC can be an incidental finding in asymptomatic patients and considered a benign condition, it can also present as a life-threatening emergency with bowel necrosis and obstruction requiring emergency surgical intervention. Also, when PC mimics malignancy, surgical management is the most appropriate step to ensure that the diagnosis of cancer is not missed.

scholarly journals Risk of Advanced Neoplasia Using the National Cancer Institute’s Colorectal Cancer Risk Assessment Tool

2016 ◽  
Vol 109 (1) ◽  
Author(s):  
Thomas F Imperiale ◽  
Menggang Yu ◽  
Patrick O Monahan ◽  
Timothy E Stump ◽  
Rebeka Tabbey ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Assessment ◽  
Assessment Tool ◽  
Colorectal Neoplasia ◽  
Risk Assessment Tool ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Tubular Adenoma ◽  
Advanced Neoplasia ◽  
Current Risk

Background: There is no validated, discriminating, and easy-to-apply tool for estimating risk of colorectal neoplasia. We studied whether the National Cancer Institute’s (NCI’s) Colorectal Cancer (CRC) Risk Assessment Tool, which estimates future CRC risk, could estimate current risk for advanced colorectal neoplasia among average-risk persons. Methods: This cross-sectional study involved individuals age 50 to 80 years undergoing first-time screening colonoscopy. We measured medical and family history, lifestyle information, and physical measures and calculated each person’s future CRC risk using the NCI tool’s logistic regression equation. We related quintiles of future CRC risk to the current risk of advanced neoplasia (sessile serrated polyp or tubular adenoma ≥ 1 cm, a polyp with villous histology or high-grade dysplasia, or CRC). All statistical tests were two-sided. Results: For 4457 (98.5%) with complete data (mean age = 57.2 years, SD = 6.6 years, 51.7% women), advanced neoplasia prevalence was 8.26%. Based on quintiles of five-year estimated absolute CRC risk, current risks of advanced neoplasia were 2.1% (95% confidence interval [CI] = 1.3% to 3.3%), 4.8% (95% CI = 3.5% to 6.4%), 6.4% (95% CI = 4.9% to 8.2%), 10.0% (95% CI = 8.1% to 12.1%), and 17.6% (95% CI = 15.5% to 20.6%; P < .001). For quintiles of estimated 10-year CRC risk, corresponding current risks for advanced neoplasia were 2.2% (95% CI = 1.4% to 3.5%), 4.8% (95% CI = 3.5% to 6.4%), 6.5% (95% CI = 5.0% to 8.3%), 9.3% (95% CI = 7.5% to 11.4%), and 18.4% (95% CI = 15.9% to 21.1%; P < .001). Among persons with an estimated five-year CRC risk above the median, current risk for advanced neoplasia was 12.8%, compared with 3.7% among those below the median (relative risk = 3.4, 95 CI = 2.7 to 4.4). Conclusions: The NCI’s Risk Assessment Tool, which estimates future CRC risk, may be used to estimate current risk for advanced neoplasia, making it potentially useful for tailoring and improving CRC screening efficiency among average-risk persons.

scholarly journals The Detection of Proximal Colon Polyps and Its Importance in Screening Colonoscopy

2017 ◽  
Vol 2 (3) ◽  
pp. 219-223
Author(s):  
Răzvan Opaschi ◽  
Simona Bățagă ◽  
Ioan Macarie ◽  
Imola Török ◽  
Anca Negovan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Sigmoid Colon ◽  
Histopathological Examination ◽  
Proximal Colon ◽  
Screening Colonoscopy ◽  
Colon Polyps ◽  
Tubular Adenoma ◽  
Right Colon ◽  
Multiple Biopsies ◽  
The Right

Abstract Background: Colon polyps are precursors of colorectal cancer (CRC), therefore their endoscopic detection is very important. A shift of in the localization of colorectal polyps toward the proximal colon has been recently observed in Western countries. Aim: The aim of this paper was to establish the most important clinical and endoscopic aspects of right colon polyps and to correlate them with their histopathological types, with an emphasis on sessile serrated adenomas/polyps (SSA/Ps). Material and method: We perfomed a retrospective study on a series of consecutive patients who underwent colonoscopy in the Gastroenterology and Endoscopy Unit of the County Emergency Clinical Hospital of Tîrgu Mureș between January 1, 2010 – December 31, 2014, comparing the results with those of patients who underwent colonoscopy between January 1, 2005 – December 31, 2009. In all cases with abnormal aspects at endoscopy, multiple biopsies were taken for histopathological examination. Only cases where the diagnosis of colon polyp was confirmed by the Histopathology Department were included in the study. Results: In the 2010–2014 period there were 871 patients diagnosed with colon polyps (1,038 polyps), with a mean age of 62.28 years. The most frequent histopathological form was tubular adenoma in 55.97% of cases (n = 581). SSA/Ps were found in 66 patients (75 polyps). Considering all polyps, the most frequent localization was in the sigmoid colon in 32.36% of cases (n = 336), but for SSA/Ps the most common localization was the ascending colon in 24% of cases (n = 18), followed by the sigmoid colon in 21.33% of cases (n = 16). Compared with patients investigated between 2005 and 2009, we found an increasing localization in the right colon, from 10.43% (n = 67) in 2005–2009 to 15.41% (n = 160) in 2010–2014. SSA/Ps were found in the right colon in 5.97% of cases (n = 4) in the first period compared with 11.25% of cases (n = 18) in the second period. Conclusions: In the last years we found an increasing localization of colon polyps in the right colon. These findings underscore the importance of high quality colonoscopy to maximize protection against colorectal cancer.

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