Abstract
Background: It is known that screening colonoscopy has the greatest impact on colorectal CA mortality, largely because of the probability that polypectomy can prevent colon cancer in most cases; but the cost effectiveness of this policy was questioned because of the lack of data about the yield of this test in average risk patients. Methods: Screening colonoscopy is offered at our institution to average risk patients starting at the age of fifty, in compliance with latest ACS recommendation. The prevalence of colon adenomas and colon CA was compared in this group with the group of patients who underwent colonoscopy for fecal occult blood test positive (FOBT+). The statistical analysis was done between these groups by using a Chi-square and T test. Results: Group one was the screening arm and had 137 cases, Group two was the FOBT+ and had 129 cases. Patients were excluded if they have first degree relative with colon cancer, previous history of colonic neoplasms, or if they have iron deficiency anemia. No statistically significant differences in prevalence of adenomas or colon Ca was noted between these two groups; although the group size could be a factor as the projected sample size needs to reach 1000 patients in each arm for adequate statistical analysis, but the high prevalence of adenomas in average risk patients may negate the need for such sample size to reach a clinical conclusion about this recommendation. Conclusion: Screening colonoscopy is an excellent way to detect and remove colon adenomas and in our study the yield is comparable to colonoscopy in FOBT+, which may indicate that having a one in a life time colonoscopy or repeated every 10 years can be cost effective. Patient's compliance and acceptance seems to be good when they offered this screening modality instead of annual FOBT with flex sig every 3 to 5 years.
Published Version
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