Fecal occult blood testing is being introduced for population screening in the United Kingdom.
Flexible sigmoidoscopy may provide a viable alternative.
The outcomes of the flexible sigmoidoscopy trial are awaited.
However, the most obvious disadvantage is that only the lower third of the colon is examined and proximal pathology cannot be excluded.
The relationship between proximal pathology and distal findings at flexible sigmoidoscopy is uncertain.
Dr Rajeev Peravali and colleagues from the United Kingdom determined the incidence of distal neoplasia in patients with confirmed proximal cancers of the colon.
All confirmed proximal colonic cancers were identified from a database of pathology specimens at a single centre between 1999 and 2006.
|8% of the cohort would have proceeded to colonoscopy|
The research team conducted a retrospective analysis of preoperative and peri-operative mucosal imaging was conducted to identify any distal neoplasia in these patients.
A total of 348 patients were identified.
Pre- or peri-operative mucosal imaging was identified in 66%, and 21% had distal neoplasia.
The research team found that 8% of these patients would have gone on to have a colonoscopy based on the UK flexible sigmoidoscopy trial protocol.
The team observed that 92% of the cohort would not have had a colonoscopy.
Dr Peravali’s team concludes, “Nearly 80% of confirmed proximal cancers in our series did not have any demonstrable distal neoplasia.”
“Only 8% of our cohort would have proceeded to colonoscopy.”
“A very significant number of proximal cancers would not have been detected.”