Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1185_Библиотеки_им_академика_М_И_Перельмана

Cancer of the colon and rectum is the second leading cause of cancer-related death in the United States. In 1997, it was esti­mated that 131,000 Americans were diagnosed with colorec­tal cancer, and 55,000 died from this disease. undergoing screening or preventive action, approximately 1 in every 17 people in this country will develop colorectal cancer at some point in life. However, evidence is mounting that col­orectal adenocarcinoma can be prevented by detecting and removing adenomatous polyps, and that detecting early-stage cancers reduces mortality from the disease. and early-stage cancers are usually asymptomatic; cancers that have grown large enough to cause symptoms have a much worse prognosis. This contrast highlights the need for screen­ing in asymptomatic persons.

A personal history of adenomatous polyps or colorectal ade­nocarcinoma places a person at higher than average risk for the development of metachronous neoplasms. Surveillance colonoscopy is thus recommended by virtually all consensus

groups. subject of some debate, and no blanket recommendation can be given for all patients. A rational surveillance strategy should take into account the patient’s age, comorbid condi­tions, life expectancy, completeness of prior examinations, pattern of neoplastic growth, and histologic features of previously resected neoplasms. For instance, a 60-year-old patient in good health who undergoes colonoscopic poly­pectomy of a single small tubular adenoma should probably undergo surveillance colonoscopy in 3–5 years. in good health who is found to have adenomas that are multi­ple, large, or dysplastic on initial screening colonoscopy should be considered for colonoscopy at an earlier interval, such as 6–12 months. However, a 90-year-old patient with severe comorbidities and limited life expectancy would not

It is troubling that so much energy and expense is devoted to the cure of advanced or recurrent colorectal cancer in the United States, while so little is devoted to screening for polyps and early-stage cancers. It is estimated that only 10%–30% of adults older than the age of 50 in this country undergo any regular screening for colorectal neoplasia. In a report issued in 2002, the United States General Accounting Office found that colorectal cancer screening is the least utilized preventive health benefit available to Medicare beneficiaries (General Accounting Office, Medicare–Beneficiary Use of Clinical Preventive Services, Report No. GAO-22-422; April 2002). As is the case in the general population, only 25% of Medicare beneficiaries are screened each year with FOBT, compared with much higher rates for other regular cancer screening tests such as mam­mography (75%) or Pap smear testing (66%). Until recently, screening for colorectal cancer has not received much public­ity in the United Sates, despite colorectal cancer being the second leading cause of cancer-related death in this country, and despite having a well-defined, identifiable, and treatable precursor lesion (the adenomatous polyp). Both health care professionals and the public need to become more aware of the potential benefits of colorectal cancer screening.