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Surveillance colonoscopy in individuals at risk for hereditary nonpolyposis colorectal cancer: an evidence-based review.
Dis Colon Rectum 2006; 49(1):80-93; discussion 94-5DC

Abstract

PURPOSE

Surveillance colonoscopy plays an important role in the management of asymptomatic patients known to carry and suspected of carrying hereditary nonpolyposis colorectal cancer gene mutations. Although the shortest interval between surveillance examinations may seem to offer the most benefit to patients, excessive use of this procedure may have unwanted consequences. This study was designed to evaluate the evidence and make recommendations regarding the optimal frequency of surveillance colonoscopy and the age at which to initiate surveillance based on the best available evidence.

METHODS

MEDLINE was searched for all articles assessing surveillance colonoscopy from 1966 to 2004 by using the MESH terms "hereditary nonpolyposis colorectal cancer" and "screening." The evidence was systematically reviewed and a critical appraisal of the evidence was performed.

RESULTS

There are no randomized, controlled, clinical trials examining the frequency of surveillance colonoscopy in hereditary nonpolyposis colorectal cancer. Three cohort studies were identified for review. There is one cohort study of good quality that provides evidence that surveillance colonoscopy every three years in patients with hereditary nonpolyposis colorectal cancer reduces the risk of developing colorectal cancer and the risk of death. The two remaining cohort studies provide poor evidence on which to make a recommendation.

CONCLUSIONS

The best available evidence supports surveillance with complete colonoscopy to the cecum every three years in patients with hereditary nonpolyposis colorectal cancer (B recommendation). There is no evidence to support or refute more frequent screening. Further research is required to examine the potential harms and benefits of more frequent screening. However, given the potential for rapid progression from adenoma to carcinoma and missing lesions at colonoscopy, there is consensus that screening more frequently than every three years is required.

Authors+Show Affiliations

IBD Research Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

16284887

Citation

Johnson, Paul M., et al. "Surveillance Colonoscopy in Individuals at Risk for Hereditary Nonpolyposis Colorectal Cancer: an Evidence-based Review." Diseases of the Colon and Rectum, vol. 49, no. 1, 2006, pp. 80-93; discussion 94-5.
Johnson PM, Gallinger S, McLeod RS. Surveillance colonoscopy in individuals at risk for hereditary nonpolyposis colorectal cancer: an evidence-based review. Dis Colon Rectum. 2006;49(1):80-93; discussion 94-5.
Johnson, P. M., Gallinger, S., & McLeod, R. S. (2006). Surveillance colonoscopy in individuals at risk for hereditary nonpolyposis colorectal cancer: an evidence-based review. Diseases of the Colon and Rectum, 49(1), pp. 80-93; discussion 94-5.
Johnson PM, Gallinger S, McLeod RS. Surveillance Colonoscopy in Individuals at Risk for Hereditary Nonpolyposis Colorectal Cancer: an Evidence-based Review. Dis Colon Rectum. 2006;49(1):80-93; discussion 94-5. PubMed PMID: 16284887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surveillance colonoscopy in individuals at risk for hereditary nonpolyposis colorectal cancer: an evidence-based review. AU - Johnson,Paul M, AU - Gallinger,Steven, AU - McLeod,Robin S, PY - 2005/11/15/pubmed PY - 2006/1/21/medline PY - 2005/11/15/entrez SP - 80-93; discussion 94-5 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 49 IS - 1 N2 - PURPOSE: Surveillance colonoscopy plays an important role in the management of asymptomatic patients known to carry and suspected of carrying hereditary nonpolyposis colorectal cancer gene mutations. Although the shortest interval between surveillance examinations may seem to offer the most benefit to patients, excessive use of this procedure may have unwanted consequences. This study was designed to evaluate the evidence and make recommendations regarding the optimal frequency of surveillance colonoscopy and the age at which to initiate surveillance based on the best available evidence. METHODS: MEDLINE was searched for all articles assessing surveillance colonoscopy from 1966 to 2004 by using the MESH terms "hereditary nonpolyposis colorectal cancer" and "screening." The evidence was systematically reviewed and a critical appraisal of the evidence was performed. RESULTS: There are no randomized, controlled, clinical trials examining the frequency of surveillance colonoscopy in hereditary nonpolyposis colorectal cancer. Three cohort studies were identified for review. There is one cohort study of good quality that provides evidence that surveillance colonoscopy every three years in patients with hereditary nonpolyposis colorectal cancer reduces the risk of developing colorectal cancer and the risk of death. The two remaining cohort studies provide poor evidence on which to make a recommendation. CONCLUSIONS: The best available evidence supports surveillance with complete colonoscopy to the cecum every three years in patients with hereditary nonpolyposis colorectal cancer (B recommendation). There is no evidence to support or refute more frequent screening. Further research is required to examine the potential harms and benefits of more frequent screening. However, given the potential for rapid progression from adenoma to carcinoma and missing lesions at colonoscopy, there is consensus that screening more frequently than every three years is required. SN - 0012-3706 UR - https://www.unboundmedicine.com/medline/citation/16284887/Surveillance_colonoscopy_in_individuals_at_risk_for_hereditary_nonpolyposis_colorectal_cancer:_an_evidence_based_review_ L2 - http://link.springer.com/article/10.1007/s10350-005-0228-0 DB - PRIME DP - Unbound Medicine ER -