Adenomas and hyperplastic polyps in screening studies.
A survey is given of colorectal polyps detected in a prospective randomized screening study with the fecal occult blood test. It is demonstrated that colonoscopy in persons with positive Hemoccult-II tests results in detection of and removal of a higher number of adenomas than among controls. The strategy may, therefore, possibly be followed by a reduction of the incidence of colorectal cancer. Screen-detected adenomas were most often in males and were larger than among controls; they were most often in the sigmoid colon, whereas the rectum was the most frequent location for adenomas in controls. Eight percent of persons with screen-detected adenomas had some symptoms, which could be referred to adenomas, in contrast to 50% among controls. Hyperplastic polyps served as markers for adenomas in persons with positive Hemoccult-II as well as in controls with adenomas detected by colonoscopy; however, most persons with adenomas had no hyperplastic polyps. Endoscopic polypectomy did not result in any severe complications, but surgical removal in 2 of 22 patients proved fatal. The results presented are compared with those of other prospective randomized trials. The optimistic view--that the incidence of cancer may be reduced by polypectomy in persons with positive Hemoccult-II tests--stresses the importance of securing optimal colonoscopy service.
Bech
K
K
Department of Surgical Gastroenterology, Odense University Hospital, Denmark.
Kronborg
O
O
Fenger
C
C
D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D003718:Denmark; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D011446:Prospective Studies; D011897:Random Allocation