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| |  Symptomatic 40- to 49-Year-Old Patients Need Full Colonoscopies, Colon Cancer Researchers Report By Bruce Sylvester CHICAGO, IL -- May 23, 2005 -- Diagnostic colonoscopies of patients age 40 to 49 years old who present with hematochezia or occult bleeding show a significant rate of precancerous polyps requiring intervention, researchers reported here on May 17th at Digestive Diseases Week (DDW). The most important finding, the researchers said, is that these patients have a 20% chance of having a precancerous polyp when they undergo colonoscopy, although advanced cancer is rarely found The study was presented by Daniel Herzig, surgical fellow, University of Texas Medical Center, Houston, Texas, and former surgical resident at Brown University School of Medicine in Providence, Rhode Island, where the study was conducted. "About a third of these lesions would not be seen on a flexible sigmoidoscopy, and a full colonoscopy is needed," Dr. Herzig added. The researchers noted that even though screening colonoscopy is recommended after the age of 50, colonoscopy is not usually performed on persons under 50 unless there are symptoms or a family history of colon cancer. The investigators retrospectively reviewed endoscopic findings and clinical results for 1169 subjects ages 40 to 49 during a 3-year study period. From this group, 582 had presented with either hematochezia or occult bleeding. The investigators grouped their pathological findings as follows: high-risk lesions (cancer, dysphasia, adenoma > 1cm, unresectable villous adenoma); low-risk lesions (adenoma < 1 cm); benign (hyperplastic polyps). In total, 388 of the patients with hematochezia as the chief symptom underwent colonoscopy, and 22 (6%) of them were found to have high-risk lesions. Six of these subjects were diagnosed with cancer, 10 with unresectable villous adenoma, 5 with adenoma > 1cm and 2 with polyps with dysphasia. In addition, 59 (15%) showed adenomas < 1cm. The rest of the subjects had a high rate of benign conditions, 74 (19%) with hyperplastic polyps and 232 (60%) with no pathology. Of the entire study group, 194 reported occult bleeding prior to colonoscopy. Of these subjects, 16 (8%) had high-risk lesions. One patient was diagnosed with colon cancer, 11 showed unresectable villous adenoma, 4 had adenomas > 1cm and 37 (19%) showed adenomas < 1cm. The rest of this cohort showed benign results, with 41 (21%) having hyperplasic polyps, and 100 (52%) showing no pathology. In total, 94 subjects (48%) in this group required polypectomy, less than half for hyperplastic polyps. The investigators also noted that of the 39 subjects with high-risk lesions, 12 (31%) showed lesions proximal to the splenic flexure. "This leads us to conclude that colonoscopy should be performed on all patients in this age group with rectal bleeding in spite of the fact that current guidelines do not define treatment for patients in this age group, and screening colonoscopy is generally not performed until the patient is 50 years old," Dr. Herzig said.
[Presentation title: Findings of Diagnostic Colonoscopy in 582 Patients Age 40-49 Presenting With Hematochezia or Occult Bleeding. Poster W1107]
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