Initial Colonoscopy Key to Cancer Detection

(Page 2)

However, the new analysis parsed those observations -- revealing that the lion's share of the benefit goes to the initial colonoscopy, not the follow-up surveillance.

The new findings also suggest that too much reliance on follow-up screenings -- which can strain health-care resources while exposing patients to the usual risks associated with any invasive procedure -- may be unjustified, the researchers said.

Still, Zauber said that follow-up colonoscopies aren't without some long-term merit. Over time, the relative importance of such surveillance rises, she noted -- ultimately accounting for approximately 45 percent of colon cancer risk reduction in the second decade following a first colonoscopy.

Zauber stressed that the new findings should not alter current American College of Gastroenterology recommendations about shorter-term surveillance: Namely, that high-risk patients -- such as those with a previous history of colon cancer or polyps -- should undergo follow-up colonoscopies every three to five years.

"The guidelines are quite good for higher-risk patients," Zauber said. "And I would not want to discourage people from surveillance. Lower-risk patients, however, could perhaps wait till the later part of that follow-up period before coming back for another colonoscopy."

Dr. Joseph Martz, chief of the division of colorectal surgery at Beth Israel Medical Center in New York City, also placed a premium on follow-up care.

"Surveillance is very important because 3 and 4 percent of polyps greater than 1 centimeter in size could be missed on a first colonoscopy," he noted. "Hidden behind a fold, hidden elsewhere. And if you miss a polyp the first time it has the potential to develop into cancer over three years, over five years. So, you can't minimize the importance of continued surveillance, even if this study shows that the benefit may be equivocal in the first 10 years."

Two other colon cancer studies -- both focused on elderly screening -- were presented Monday at the gastroenterology meeting.