Natural History |
Prevalence of adenomatous polyps |
|
|
15–19
|
Age 50 yr |
20% |
10–30% |
|
Age 60 yr |
40% |
30–50% |
|
Age 70 yr |
50% |
40–60% |
|
Age 80 yr |
55% |
45–65% |
|
In patients with adenomas: |
Proportion of adenomas that are high-risk |
15% |
5–25% |
15–19
|
Annual incidence of colorectal cancer |
|
|
2 |
Age 50 yr |
0.05% |
– |
|
Age 55 yr |
0.09% |
– |
|
Age 60 yr |
0.14% |
– |
|
Age 65 yr |
0.20% |
– |
|
Age 70 yr |
0.27% |
– |
|
Age 75 yr |
0.35% |
– |
|
Age 80 yr |
0.43% |
– |
|
Age 85 yr |
0.45% |
– |
|
5-yr colorectal cancer mortality |
|
|
20 |
Localized |
10.5% |
– |
|
Regional |
35.1% |
– |
|
Disseminated |
91.7% |
– |
|
Test Characteristics |
Sensitivity of 2-D VC for adenomas 1–5 mm |
33% |
14–57% |
13 |
Sensitivity of 2-D VC for adenomas 6–9 mm |
50% |
30–83% |
13 |
Sensitivity of 2-D VC for adenomas ≥ 10 mm |
82% |
55–95% |
13 |
Specificity of 2-D VC |
91% |
85–97% |
13 |
Sensitivity of 3-D VC for adenomas 1–5 mm |
46% |
25–56% |
13 |
Sensitivity of 3-D VC for adenomas 6–9 mm |
83% |
42–94% |
13 |
Sensitivity of 3-D VC for adenomas ≥10 mm |
91% |
80–100% |
13 |
Specificity of 3-D VC |
91% |
85–97% |
13 |
Sensitivity of FOBT for adenomas |
5% |
2–10% |
21–27
|
Specificity of FOBT |
97.5% |
90–100% |
21–23;26;27
|
Sensitivity of FOBT for cancer |
|
|
21;23–27
|
Localized |
30% |
20–40% |
|
Regional |
50% |
40–60% |
|
Neoplasia reachable by sigmoidoscopy |
55% |
40–75% |
5;28–30
|
Sensitivity of optical colonoscopy/sigmoidoscopy for adenomas < 1 cm |
85% |
80–95% |
29;31–36
|
Sensitivity of optical colonoscopy/sigmoidoscopy for adenomas > 1 cm or cancer |
95% |
90–100% |
29;31–36
|
Perforation rate—optical colonoscopy |
0.1% |
0.0–0.3% |
37–39
|
Mortality rate—perforation |
7.5% |
5–10% |
28;40
|
Costs |
CT colonography |
$559 |
$100–$1,400 |
41 |
Fecal occult-blood testing |
$18 |
$5–$30 |
42 |
Flexible sigmoidoscopy |
$389 |
$100–$500 |
41 |
Flexible sigmoidoscopy with biopsy and pathology |
$492 |
$100–$550 |
41 |
Optical colonoscopy |
$653 |
$150–$1,400 |
41;43
|
Polypectomy (including pathology) |
$178 |
$100–$300 |
41 |
Cancer care |
|
|
28;44–52
|
Localized |
$34,300 |
$20,000–$60,000 |
|
Regional |
$47,230 |
$30,000–$80,000 |
|
Disseminated |
$41,600 |
$30,000–$70,000 |
|
Cost of treating colon perforation |
$22,269 |
$10,000–$30,000 |
40;47
|