MONDAY, Feb. 24, 2003 (HealthDayNews) -- Despite ample evidence that people who have had polyps removed from their colon are at a higher risk for a recurrence, this group is not getting screened as often as it should.
In fact, only slightly more than half (52 percent) of people who had had polyps showed up for another screening in the follow-up period, says a paper appearing in the Feb. 24 Archives of Internal Medicine.
The article also verified that this group did have a higher recurrence of polyps, or small growths in the colon or rectum.
"The single most important point of this article, from my standpoint, is that it confirms that surveillance following a colonoscopy is important because there's a high likelihood of recurrent polyps," says Dr. Michael Spencer, associate clinical professor of surgery at the University of Minnesota in Minneapolis and a member of the American Society of Colon and Rectal Surgeons.
Colorectal cancers are the third most common cancers in men and women after skin cancer, says the American Cancer Society. Virtually all cancers come from polyps, a fact which makes early detection and removal especially crucial.
According to the study authors, 37 percent to 60 percent of patients who have had a polypectomy (removal of polyps) are found to have more polyps at a later date.
New screening guidelines issued in February by the U.S. Multisociety Task Force on Colorectal Cancer recommend that individuals who have had one or two small polyps removed have their first follow-up colonoscopy at five years. Patients with at lest three of the growths should get their first follow-up colonoscopy at three years.
In this study, researchers looked at 8,865 patients who belonged to the same large health maintenance organization (HMO) in the Midwest that offered colorectal cancer screening as one of its benefits. All of the participants were at least 50 years old and had undergone a polypectomy between Jan. 1, 1989, and Dec. 31, 1999. Participants were followed up through Sept. 1, 2001.
Of the total initial sample, 2,704 patients (or 30.5 percent) were diagnosed with recurrent polyps, a number not dramatically different from previous accounts. Estimates suggest that about half the participants will have a recurrence within 7.6 years. Among those who had a colonoscopy at least nine months after removal of polyps, 50 percent will probably have a recurrence within 3.9 years.
There were no major differences in the results by gender, race or age. The results were also akin to those found in other studies.
"We're finding results that are similar, but these are updated," says Marianne Yood, an epidemiologist and lead author of the study. "That's not the huge shocker."
The real shocker was that only 52 percent of the patients turned up for follow-up screening after their first procedure. "Half of the patients did not come back," Yood remarks. "One of the study restrictions was that patients had to be enrolled for at least one year after the polypectomy, 28 percent were enrolled more than five years, 13 percent more than seven years. I figure that they should all have come back at least once a year afterwards."
"Obviously, physicians, the health-care community and others are not doing a good job in relaying the importance to the American public of screening for this disease," Spencer says. "These are people who should understand better than most the importance."
Yood feels that the study indicates a need for other preventive measures. "Screening is really, really important, but I personally would like to see a focus on pharmaceutical interventions," she says.
There is evidence that NSAIDs (nonsteroidal anti-inflammatory drugs, used for conditions such as arthritis) may decrease the risk for colon cancer. "There may be a role for putting that into some of the guidelines," says Yood. "I really believe that there's a lot of literature out there on NSAIDs, and I don't think it's incorporated into clinical practice."
For now, screening, particularly in the form of a colonoscopy, will help prevent colorectal cancers.
Perhaps introducing some uniformity among health-care plans will help in the effort to increase screening rates. "Somehow screening and risk assessment procedures need to have universal applications throughout health plans," Spencer says. "Why can't we just have a health screening card that has our general information, evaluations, risk factors? It's a simple thing that you could do and swipe in at any hospital."
More information
For more on polyps and colorectal cancer, visit the National Cancer Institute or the American Cancer Society.
