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

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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.
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Document Type: Research Article

Affiliations: From the Department of Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia

Publication date: August 1, 2009

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  • The Southeastern Surgical Congress owns and publishes The American Surgeon monthly. It is the official journal of the Congress and the Southern California Chapter of the American College of Surgeons, which all members receive each month. The journal brings up to date clinical advances in surgical knowledge in a popular reference format. In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts. If you have a manuscript you'd like to see published in The American Surgeon select "Information for Authors" from the Related Information options below. A Copyright Release Form must accompany all manuscripts submitted.
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