Colon Cancer Screening Tied to Better Outcomes

June 21, 2013

By Andrew M. Seaman

NEW YORK (Reuters Health) Jun 21 - People who are diagnosed with colon cancer after routine colonoscopies tend to have better outcomes and less advanced cancers than people diagnosed based on symptoms, says a new study.

Those who were diagnosed with colon cancer as a result of symptoms were three times more likely to die during the study than the patients diagnosed after colonoscopy screenings, researchers found.

"It's in line with its current use. It shows that colonoscopy appears to be beneficial in reducing deaths in those diagnosed with colorectal cancer," said Dr. Chyke Doubeni, who studies colonoscopy use but wasn't involved in the new research.

The study authors say the incidence of colon cancer in the U.S. has dropped by about 6% since the first national colonoscopy guidelines were introduced in 2000, mostly due to detection and removal of precancerous polyps during screening.

Still, the U.S. Centers for Disease Control and Prevention reports that about 22 million people are not up-to-date with their colon cancer screenings.

For the new study, Dr. Ramzi Amri and colleagues from Massachusetts General Hospital in Boston analyzed data on all patients who had colon cancer surgery at their hospital from 2004 through 2011.

Their goal was to see whether those diagnosed after colonoscopy screenings had better outcomes than patients diagnosed after developing symptoms, such as rectal bleeding.

Dr. Amri and his colleagues had data on 217 people diagnosed after screening and 854 who were diagnosed based on symptoms or other tests.

They found that in addition to being more likely to die during the study period, patients diagnosed with colon cancer based on symptoms were far more likely to have advanced disease, to have cancer that spread to other parts of their bodies and to have cancer that recurred.

Seventy-five percent of patients diagnosed based on their symptoms had advanced disease, compared to about 38% of those diagnosed after colonoscopy screening.

About 11% of the group diagnosed with symptoms had metastatic disease, and 12% had recurrences, compared to about 2% and 6%, respectively, in the colonoscopy group.

"This further emphasizes the important role compliance to screening colonoscopy guidelines can play in prolonging longevity, improving quality of life, and reducing health care costs through early detection of colon cancer," the researchers wrote June 19th online in JAMA Surgery.

"This definitely supports the practice that we should be screened for colorectal cancer, but I wouldn't go as far to say colonoscopy is the only thing that should be used," said Dr. Doubeni, of the University of Pennsylvania's Perelman School of Medicine.

The USPSTF also gives people the option of annual high-sensitivity fecal occult blood testing, or sigmoidoscopy every five years combined with high-sensitivity fecal occult blood testing every three years.

The new study's authors do acknowledge some of its limitations, including the fact that their data was drawn from a hospital that receives more severe colon cancer cases from other hospitals, which means the results may have exaggerated the differences between the two groups.


JAMA Surgery 2013.


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