Skip to main content
PMC home page
Gut logoLink to Gut
. 1999 Dec;45(6):834–839. doi: 10.1136/gut.45.6.834

Flexible sigmoidoscopy or colonoscopy as a screening modality for colorectal adenomas in older age groups? Findings in a cohort of the normal population aged 63-72 years

E Thiis-Evensen 1, G Hoff 1, J Sauar 1, B Majak 1, M Vatn 1
PMCID: PMC1727750  PMID: 10562581

Abstract

BACKGROUND—Most cases of colorectal cancer originate from adenomas. Removing adenomas has been shown to reduce the incidence of colorectal cancer. The design of cost effective endoscopic screening programmes requires a knowledge of the distribution of adenomas in different age groups.
AIM—To investigate the distribution of colorectal adenomas in older age groups in the normal population.
METHOD—A total of 356 men and women selected randomly from the population register were offered a colonoscopic screening examination to detect and remove polyps.
RESULTS—In all, 241(68%) subjects, mean age 67.4 years (range 62-73), attended. The caecum was intubated in 193 (80%), and in this group 32 (38%) women and 51 (47%) men had adenomas. One hundred and ten (54%) of the adenomas and 11 (39%) of the "high risk adenomas" (adenomas larger than 10 mm in diameter, adenomas containing villous components, and adenomas with severe dysplasia) were found proximal to the sigmoid colon. In 36 (43%) of the subjects with adenomas, the adenomas were only found proximal to the sigmoid colon. Twenty two (11%) subjects had more than two adenomas. Of 203 adenomas discovered, 189 (93%) were less than 10 mm in diameter.
CONCLUSION—More than half of the adenomas were localised proximal to the sigmoid colon, and, in nearly half of the adenoma bearing subjects examined, the adenoma was proximal to the descending colon. This indicates that a sigmoidoscopic screening examination in this age group would miss a substantial number of adenomas, but this may be acceptable as the vast majority of proximal adenomas do not progress to clinical cancer within the life expectancy of this age group.


Keywords: adenoma; colon; colorectal neoplasms; endoscopy; epidemiology; polyps

Full Text

The Full Text of this article is available as a PDF (103.2 KB).

Figure 1  .

Figure 1  

Open in a new tab

Percentage distribution of subjects with caecum intubated categorised according to number of adenomas found (none, 1-2, 3-5, 6-10 and more than 10). Total number of individuals in each category is given under the bars, which express percentage of individuals in each category.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ARMINSKI T. C., MCLEAN D. W. INCIDENCE AND DISTRIBUTION OF ADENOMATOUS POLYPS OF THE COLON AND RECTUM BASED ON 1,000 AUTOPSY EXAMINATIONS. Dis Colon Rectum. 1964 Jul-Aug;7:249–261. doi: 10.1007/BF02630528. [DOI] [PubMed] [Google Scholar]
  2. Ansher A. F., Lewis J. H., Fleischer D. E., Cattau E. L., Jr, Collen M. J., O'Kieffe D. A., Korman L. Y., Benjamin S. B. Hyperplastic colonic polyps as a marker for adenomatous colonic polyps. Am J Gastroenterol. 1989 Feb;84(2):113–117. [PubMed] [Google Scholar]
  3. Atkin W. S., Morson B. C., Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992 Mar 5;326(10):658–662. doi: 10.1056/NEJM199203053261002. [DOI] [PubMed] [Google Scholar]
  4. Bedenne L., Faivre J., Boutron M. C., Piard F., Cauvin J. M., Hillon P. Adenoma--carcinoma sequence or "de novo" carcinogenesis? A study of adenomatous remnants in a population-based series of large bowel cancers. Cancer. 1992 Feb 15;69(4):883–888. doi: 10.1002/1097-0142(19920215)69:4<883::aid-cncr2820690408>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  5. Blue M. G., Sivak M. V., Jr, Achkar E., Matzen R., Stahl R. R. Hyperplastic polyps seen at sigmoidoscopy are markers for additional adenomas seen at colonoscopy. Gastroenterology. 1991 Feb;100(2):564–566. doi: 10.1016/0016-5085(91)90232-a. [DOI] [PubMed] [Google Scholar]
  6. Brady P. G., Straker R. J., McClave S. A., Nord H. J., Pinkas M., Robinson B. E. Are hyperplastic rectosigmoid polyps associated with an increased risk of proximal colonic neoplasms? Gastrointest Endosc. 1993 Jul-Aug;39(4):481–485. doi: 10.1016/s0016-5107(93)70155-8. [DOI] [PubMed] [Google Scholar]
  7. CHAPMAN I. Adenomatous polypi of large intestine: incidence and distribution. Ann Surg. 1963 Feb;157:223–226. doi: 10.1097/00000658-196302000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Church J. M. Complete colonoscopy: how often? And if not, why not? Am J Gastroenterol. 1994 Apr;89(4):556–560. [PubMed] [Google Scholar]
  9. Clark J. C., Collan Y., Eide T. J., Estève J., Ewen S., Gibbs N. M., Jensen O. M., Koskela E., MacLennan R., Simpson J. G. Prevalence of polyps in an autopsy series from areas with varying incidence of large-bowel cancer. Int J Cancer. 1985 Aug 15;36(2):179–186. doi: 10.1002/ijc.2910360209. [DOI] [PubMed] [Google Scholar]
  10. Correa P., Strong J. P., Johnson W. D., Pizzolato P., Haenszel W. Atherosclerosis and polyps of the colon. Quantification of precursors of coronary heart disease and colon cancer. J Chronic Dis. 1982;35(5):313–320. doi: 10.1016/0021-9681(82)90002-9. [DOI] [PubMed] [Google Scholar]
  11. DiSario J. A., Foutch P. G., Mai H. D., Pardy K., Manne R. K. Prevalence and malignant potential of colorectal polyps in asymptomatic, average-risk men. Am J Gastroenterol. 1991 Aug;86(8):941–945. [PubMed] [Google Scholar]
  12. Duthie G. S., Drew P. J., Hughes M. A., Farouk R., Hodson R., Wedgwood K. R., Monson J. R. A UK training programme for nurse practitioner flexible sigmoidoscopy and a prospective evaluation of the practice of the first UK trained nurse flexible sigmoidoscopist. Gut. 1998 Nov;43(5):711–714. doi: 10.1136/gut.43.5.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Eide T. J., Stalsberg H. Polyps of the large intestine in Northern Norway. Cancer. 1978 Dec;42(6):2839–2848. doi: 10.1002/1097-0142(197812)42:6<2839::aid-cncr2820420645>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
  14. Farrands P. A., Hardcastle J. D., Chamberlain J., Moss S. Factors affecting compliance with screening for colorectal cancer. Community Med. 1984 Feb;6(1):12–19. [PubMed] [Google Scholar]
  15. Foutch P. G., Mai H., Pardy K., DiSario J. A., Manne R. K., Kerr D. Flexible sigmoidoscopy may be ineffective for secondary prevention of colorectal cancer in asymptomatic, average-risk men. Dig Dis Sci. 1991 Jul;36(7):924–928. doi: 10.1007/BF01297142. [DOI] [PubMed] [Google Scholar]
  16. Gilbertsen V. A. Proctosigmoidoscopy and polypectomy in reducing the incidence of rectal cancer. Cancer. 1974 Sep;34(3):suppl–suppl:939. doi: 10.1002/1097-0142(197409)34:3+<936::aid-cncr2820340722>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  17. Hayward R. A., Shapiro M. F., Freeman H. E., Corey C. R. Who gets screened for cervical and breast cancer? Results from a new national survey. Arch Intern Med. 1988 May;148(5):1177–1181. [PubMed] [Google Scholar]
  18. Hixson L. J., Fennerty M. B., Sampliner R. E., McGee D., Garewal H. Prospective study of the frequency and size distribution of polyps missed by colonoscopy. J Natl Cancer Inst. 1990 Nov 21;82(22):1769–1772. doi: 10.1093/jnci/82.22.1769. [DOI] [PubMed] [Google Scholar]
  19. Hoff G., Vatn M. Epidemiology of polyps in the rectum and sigmoid colon. Endoscopic evaluation of size and localization of polyps. Scand J Gastroenterol. 1985 Apr;20(3):356–360. doi: 10.3109/00365528509091664. [DOI] [PubMed] [Google Scholar]
  20. Hoff G., Vatn M., Gjone E., Larsen S., Sauar J. Epidemiology of polyps in the rectum and sigmoid colon. Design of a population screening study. Scand J Gastroenterol. 1985 Apr;20(3):351–355. doi: 10.3109/00365528509091663. [DOI] [PubMed] [Google Scholar]
  21. Hofstad B., Vatn M. H., Andersen S. N., Huitfeldt H. S., Rognum T., Larsen S., Osnes M. Growth of colorectal polyps: redetection and evaluation of unresected polyps for a period of three years. Gut. 1996 Sep;39(3):449–456. doi: 10.1136/gut.39.3.449. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Johnson D. A., Gurney M. S., Volpe R. J., Jones D. M., VanNess M. M., Chobanian S. J., Avalos J. C., Buck J. L., Kooyman G., Cattau E. L., Jr A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol. 1990 Aug;85(8):969–974. [PubMed] [Google Scholar]
  23. Lieberman D. A., Smith F. W. Frequency of isolated proximal colonic polyps among patients referred for colonoscopy. Arch Intern Med. 1988 Feb;148(2):473–475. [PubMed] [Google Scholar]
  24. Lieberman D. A., Smith F. W. Screening for colon malignancy with colonoscopy. Am J Gastroenterol. 1991 Aug;86(8):946–951. [PubMed] [Google Scholar]
  25. Maclean U., Sinfield D., Klein S., Harnden B. Women who decline breast screening. J Epidemiol Community Health. 1984 Dec;38(4):278–283. doi: 10.1136/jech.38.4.278. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Maule W. F. Screening for colorectal cancer by nurse endoscopists. N Engl J Med. 1994 Jan 20;330(3):183–187. doi: 10.1056/NEJM199401203300307. [DOI] [PubMed] [Google Scholar]
  27. Morson B. President's address. The polyp-cancer sequence in the large bowel. Proc R Soc Med. 1974 Jun;67(6 Pt 1):451–457. [PMC free article] [PubMed] [Google Scholar]
  28. Provenzale D., Garrett J. W., Condon S. E., Sandler R. S. Risk for colon adenomas in patients with rectosigmoid hyperplastic polyps. Ann Intern Med. 1990 Nov 15;113(10):760–763. doi: 10.7326/0003-4819-113-10-760. [DOI] [PubMed] [Google Scholar]
  29. Provenzale D., Martin Z. Z., Holland K. L., Sandler R. S. Colon adenomas in patients with hyperplastic polyps. J Clin Gastroenterol. 1988 Feb;10(1):46–49. doi: 10.1097/00004836-198802000-00011. [DOI] [PubMed] [Google Scholar]
  30. Rex D. K., Lehman G. A., Hawes R. H., Ulbright T. M., Smith J. J. Screening colonoscopy in asymptomatic average-risk persons with negative fecal occult blood tests. Gastroenterology. 1991 Jan;100(1):64–67. doi: 10.1016/0016-5085(91)90583-7. [DOI] [PubMed] [Google Scholar]
  31. Rex D. K., Lehman G. A., Ulbright T. M., Smith J. J., Pound D. C., Hawes R. H., Helper D. J., Wiersema M. J., Langefeld C. D., Li W. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol. 1993 Jun;88(6):825–831. [PubMed] [Google Scholar]
  32. Rex D. K., Smith J. J., Ulbright T. M., Lehman G. A. Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects. Gastroenterology. 1992 Jan;102(1):317–319. doi: 10.1016/0016-5085(92)91817-n. [DOI] [PubMed] [Google Scholar]
  33. Rogge J. D., Elmore M. F., Mahoney S. J., Brown E. D., Troiano F. P., Wagner D. R., Black D. J., Pound D. C. Low-cost, office-based, screening colonoscopy. Am J Gastroenterol. 1994 Oct;89(10):1775–1780. [PubMed] [Google Scholar]
  34. Selby J. V., Friedman G. D., Quesenberry C. P., Jr, Weiss N. S. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992 Mar 5;326(10):653–657. doi: 10.1056/NEJM199203053261001. [DOI] [PubMed] [Google Scholar]
  35. Shinya H., Wolff W. I. Morphology, anatomic distribution and cancer potential of colonic polyps. Ann Surg. 1979 Dec;190(6):679–683. doi: 10.1097/00000658-197912000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Squillace S., Berggreen P., Jaffe P., Fennerty M. B., Hixson L., Garewal H., Sampliner R. E. A normal initial colonoscopy after age 50 does not predict a polyp-free status for life. Am J Gastroenterol. 1994 Aug;89(8):1156–1159. [PubMed] [Google Scholar]
  37. Thiis-Evensen E., Hoff G. S., Sauar J., Langmark F., Majak B. M., Vatn M. H. Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scand J Gastroenterol. 1999 Apr;34(4):414–420. doi: 10.1080/003655299750026443. [DOI] [PubMed] [Google Scholar]
  38. Vatn M. H., Stalsberg H. The prevalence of polyps of the large intestine in Oslo: an autopsy study. Cancer. 1982 Feb 15;49(4):819–825. doi: 10.1002/1097-0142(19820215)49:4<819::aid-cncr2820490435>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  39. Vogelstein B., Fearon E. R., Hamilton S. R., Kern S. E., Preisinger A. C., Leppert M., Nakamura Y., White R., Smits A. M., Bos J. L. Genetic alterations during colorectal-tumor development. N Engl J Med. 1988 Sep 1;319(9):525–532. doi: 10.1056/NEJM198809013190901. [DOI] [PubMed] [Google Scholar]
  40. Waye J. D., Bashkoff E. Total colonoscopy: is it always possible? Gastrointest Endosc. 1991 Mar-Apr;37(2):152–154. doi: 10.1016/s0016-5107(91)70674-3. [DOI] [PubMed] [Google Scholar]
  41. Winawer S. J., Zauber A. G., Ho M. N., O'Brien M. J., Gottlieb L. S., Sternberg S. S., Waye J. D., Schapiro M., Bond J. H., Panish J. F. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993 Dec 30;329(27):1977–1981. doi: 10.1056/NEJM199312303292701. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES