Colonoscopy the Only Way for Seniors – Sigmoidoscopy
Cannot Find All the Polyps
Most older people dread the colonoscopy search for
possible colon cancer, second leading cause of cancer death in the U.S.
Oct. 8, 2013 – Senior citizens are almost universal
in their dread of the colonoscopy, which keeps many of them searching
for an easier way to guard against colon cancer. These dreams took a hit
today from research showing people over age 60 are more likely to have
precancerous or cancerous polyps develop in a part of the colon that
goes unseen by flexible sigmoidoscopy, a common screening test for colon
and rectal cancer. And the problem grows with advanced age.
This discovery suggests the need for reviewing and
possibly revising national colon cancer screening guidelines, study
authors said at the 2013 Clinical Congress of the American College of
Colonoscopy is the most accurate way to find and
remove small polyps before these growths can become colon cancer, the
second leading cause of cancer death in the U.S. in men and women
combined, according to the
American Cancer Society.
People in group, individual health plans don't pay for polyp removal
during a screening colonoscopy; feds say it is an integral part
of screening and should be covered without cost sharing -
Medicare may still require co-pay. Some remain vexed and
confused about testing that begins at age 50 for
second leading cancer killer
However, some patients prefer a procedure called
sigmoidoscopy because it is usually easier for them to undergo and
quicker for gastroenterologists and surgeons to perform. The
U.S. Preventive Services Task Force recommends screening for
colorectal cancer in adults ages 50 to 75 using either colonoscopy every
10 years or sigmoidoscopy every five years plus fecal occult blood
testing (a check for blood in the stool) every three years.
A research team from Carolinas Medical Center in
Charlotte, NC, found that polyps in patients ages 60 and older occur
more often in the beginning part of the colon on the right abdominal
side, rather than the left side, lower end of the colon, as previously
thought. The researchers used a colonoscopy procedure, which enables
the physician to see the inside of the rectum and the entire colon.
Sigmoidoscopy allows a view of only the rectum and sigmoid colon, the
lower part of the colon on the patient's left side nearest the rectum
"Based on our results, patients older than 60
should strongly consider having a colonoscopy to screen for colon
cancer," said principal investigator B. Todd Heniford, MD, FACS,
professor of surgery and chief of gastrointestinal and minimally
invasive surgery at Carolinas Medical Center. "With sigmoidoscopy,
there's a chance of missing polyps that may become cancer or already are
Using a specially created software program to
search their hospital's medical records, Dr. Heniford's research team
identified more than 120,000 colonoscopies performed between June 2003
and October 2011 in patients ages 20 to 90. Of the polyps removed during
these procedures, 72,960 had an identifiable location.
"This is one of the largest studies to date, if not
the largest, that used colonoscopy to find where colorectal polyps most
often originate and at what age," Dr. Heniford said.
Although the greatest percentage of polyps (25.5
percent) came from the sigmoid colon, the researchers found that the
predominant site for polyps differed with increasing age. Compared with
patients 60 or younger, patients older than 60 were 1.6 times more
likely to have a right-sided colon polyp, where colonoscopy - but not
sigmoidoscopy - could detect it, Dr. Heniford reported.
The results reportedly did not differ between men
and women. Dr. Heniford said the age difference was similar for the type
of polyp that most often becomes cancerous (adenomatous) but was less
pronounced for nondangerous polyps.
For each decade of age, the odds ratio of finding
polyps in the sigmoid colon was 0.88 compared with 1.22 for the cecum at
the beginning of the colon, and 1.30 for the ascending or right side of
the colon above the cecum. Therefore, in a 70-year-old patient, a polyp
would be about 2.5 times more likely to originate in the cecum or
ascending colon compared with a 50-year-old patient, Dr. Heniford
Dr. Heniford's research colleagues for the study
were: Victor B. Tsirline, MD, MS; Igor Belyansky, MD; Chelsea Conroy;
William Yokeley; Amanda L. Walters, MS; Amy E. Lincourt, PhD, MBA; Vedra
Augenstein, MD; and Ronald F. Sing, DO, FACS.
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