Non-protruding lesions

A study published in The Journal of the American Medical Association (coincidentally on the day the Guideline was released) suggested that non-polypoid lesions, which are difficult to detect by colonoscopy or CTC, are more common and more likely to be malignant than previously thought. Among patients who were screened in the study, the incidence of malignant, non-polypoid lesions was 0.32% (JAMA. 2008;299:1027-1035). 

“If the paper had appeared earlier, it would have been mentioned in the Guideline,” Dr. Brooks declares. “It raises the question of whether colonoscopy needs to be performed differently, at least in certain segments of the population.” This could mean using a special dye, as was done in the study, or different light. At the very least, “the study underlines the importance of awareness of these lesions. I suspect we’ll see a much higher rate of detection in coming years,” he says.

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The paper also highlights the fact that colonoscopy can miss abnormalities; “if new symptoms develop a year or two after colonoscopy, they should never be ignored,” he says.

Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology was published in CA: A Cancer Journal for Clinicians (2008;58:130-

Mr. Sherman is a medical writer in New York City.