News | October 11, 2013

Colon Polyps in Elderly Patients Are More Likely to Develop in Areas Seen Only With Colonoscopy

Large, single-center study calls into question the use of sigmoidoscopy to screen for colon cancer in patients over age 60

October 11, 2013 — People over 60 years old are more likely to have precancerous or cancerous polyps develop in a part of the colon that goes unseen by flexible sigmoidoscopy, a common screening test for colon and rectal cancer, a new clinical study finds. Study results suggest the need for reviewing and possibly revising national colon cancer screening guidelines, study authors said at the 2013 Clinical Congress of the American College of Surgeons.

Colonoscopy is the most accurate way to find and remove small polyps before these growths can become colon cancer, the second leading cause of cancer death in the United States in men and women combined, according to the American Cancer Society.[1] However, some patients prefer a procedure called sigmoidoscopy because it is usually easier for them to undergo and quicker for gastroenterologists and surgeons to perform. The U.S. Preventive Services Task Force recommends screening for colorectal cancer in adults ages 50-75 using either colonoscopy every 10 years or sigmoidoscopy every five years plus fecal occult blood testing (a check for blood in the stool) every three years.[2]

A research team from Carolinas Medical Center in Charlotte, N.C., found that polyps in patients ages 60 and older occur more often in the beginning part of the colon on the right abdominal side, rather than the left side, lower end of the colon, as previously thought. The researchers used a colonoscopy procedure, which enables the physician to see the inside of the rectum and the entire colon. Sigmoidoscopy allows a view of only the rectum and sigmoid colon, the lower part of the colon on the patient's left side nearest the rectum and anus.

"Based on our results, patients older than 60 should strongly consider having a colonoscopy to screen for colon cancer," said Principal Investigator B. Todd Heniford, M.D., FACS, professor of surgery and chief of gastrointestinal and minimally invasive surgery at Carolinas Medical Center. "With sigmoidoscopy, there's a chance of missing polyps that may become cancer or already are cancer."

Using a specially created software program to search their hospital's medical records, Heniford's research team identified more than 120,000 colonoscopies performed between June 2003 and October 2011 in patients ages 20-90. Of the polyps removed during these procedures, 72,960 had an identifiable location.

"This is one of the largest studies to date, if not the largest, that used colonoscopy to find where colorectal polyps most often originate and at what age," Heniford said. Although the greatest percentage of polyps (25.5 percent) came from the sigmoid colon, the researchers found that the predominant site for polyps differed with increasing age. Compared with patients 60 or younger, patients older than 60 were 1.6 times more likely to have a right-sided colon polyp, where colonoscopy — but not sigmoidoscopy — could detect it, Heniford reported.

The results reportedly did not differ between men and women. Heniford said the age difference was similar for the type of polyp that most often becomes cancerous (adenomatous) but was less pronounced for nondangerous polyps.

For each decade of age, the odds ratio of finding polyps in the sigmoid colon was 0.88 compared with 1.22 for the cecum at the beginning of the colon, and 1.30 for the ascending or right side of the colon above the cecum. Therefore, in a 70-year-old patient, a polyp would be about 2.5 times more likely to originate in the cecum or ascending colon compared with a 50-year-old patient, Heniford estimated.

Heniford's research colleagues for the study were: Victor B. Tsirline, M.D., MS; Igor Belyansky, M.D.; Chelsea Conroy; William Yokeley; Amanda L. Walters, MS; Amy E. Lincourt, Ph.D., MBA; Vedra Augenstein, M.D.; and Ronald F. Sing, DO, FACS.

References:

1. American Cancer Society. What Are the Key Statistics About Colorectal Cancer? Available at: http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorect.... Accessed August 23, 2013.

2. U.S. Preventive Services Task Force. Screening for Colorectal Cancer: Recommendation Statement. October 2008. Available at: http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/colors..... Accessed August 23, 2013.

 

Related Content

Proton Therapy Lowers Risk of Side Effects Compared to Conventional Radiation
News | Proton Therapy | May 23, 2019
Cancer patients getting proton therapy instead of traditional photon radiation are at a significantly lower risk of...
VolparaDensity With Tyrer-Cuzick Model Improves Breast Cancer Risk Stratification
News | Breast Density | May 22, 2019
Research has demonstrated use of Volpara Solutions' VolparaDensity software in combination with the Tyrer-Cuzick Breast...
Partial Breast Irradiation Effective, Convenient Treatment Option for Low-Risk Breast Cancer
News | Radiation Therapy | May 20, 2019
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast...
AI Detects Unsuspected Lung Cancer in Radiology Reports, Augments Clinical Follow-up
News | Artificial Intelligence | May 20, 2019
Digital Reasoning announced results from its automated radiology report analytics research. In a series of experiments...
New Study Evaluates Head CT Examinations and Patient Complexity
News | Neuro Imaging | May 17, 2019
Computed tomography (CT) of the head uses special X-ray equipment to help assess head injuries, dizziness and other...
New Phase 2B Trial Exploring Target-Specific Myocardial Ischemia Imaging Agent
News | Radiopharmaceuticals and Tracers | May 17, 2019
Biopharmaceutical company CellPoint plans to begin patient recruitment for its Phase 2b cardiovascular imaging study in...
Managing Architectural Distortion on Mammography Based on MR Enhancement
News | Mammography | May 15, 2019
High negative predictive values (NPV) in mammography architectural distortion (AD) without ultrasonographic (US)...
Icon Launches New Clinical Trial Patient Engagement Platform
Technology | Patient Engagement | May 14, 2019
Icon plc announced the release of its web-based clinical trial patient engagement platform, to provide patients with...
Radiotherapy After Chemo May Improve Survival in Advanced Hodgkin's Lymphoma Patients
News | Radiation Therapy | May 10, 2019
Patients with advanced Hodgkin's lymphoma who have large tumors at the time of diagnosis may benefit from radiotherapy...
Screening MRI Detects BI-RADS 3 Breast Cancer in High-risk Patients
News | MRI Breast | May 09, 2019
When appropriate, short-interval follow-up magnetic resonance imaging (MRI) can be used to identify early-stage breast...