| 077 |
|
EFFECTIVENESS OF FLEXIBLE SIGMOIDOSCOPY AS A SCREENING TOOL FOR COLORECTAL CANCER
C Todd, D MacIntosh, J Love
Department of Medicine, Dalhousie University, Halifax, Nova Scotia
Colorectal cancer (CRC) is the second most common cancer causing death for both males and females in Canada. 610 Nova Scotians will be diagnosed with CRC in the year 2000. It is a cancer that fits the criteria for a screening program, although there is no general population screening in Canada. Flexible sigmoidoscopy (FS) is one procedure that is an option for use as a screening tool.
The Canadian Military recommends a screening FS for personnel over the age of 50. To determine the effectiveness of this approach, both in terms of successfully detecting precancerous polyps and being cost-effective, charts of average-risk patients from the Stadacona Military Hospital that had been screened between 1985 and 2000 were studied to examine the effectiveness of these procedures in detecting polyps.
There were 313 screens performed between October 1985 and June 2000. Of these procedures, 37 were excluded as not average risk. The age range was 40-59 (mean=51.2; SD=2.47). All but one of the subjects was male. Of the 276 screens, 175 (63%) had no significant findings (NSF); 63 (22.8%) were diagnosed with polyps, and 3 subjects (1%) were diagnosed with a carcinoma. Of the polyps found, 31 (49.2% of the polyp population; 9.9% of the group population) were hyperplastic, and 24 (38.1% of polyp group and 7.7% of overall group) were adenomatous. There were 12 false positive results. Thirty-one (86.1%) were <1cm in diameter. Twenty-nine (80.6%) were located in the distal 35 cm of the colon. There were 10 polyps found during follow-up colonoscopy. Six (60%) were <1cm, 2 were >1cm and 2 had no size recorded.
These results are in keeping with published results and support the effectiveness of FS as a screening tool for CRC. If adopted province wide in Nova Scotia the estimated direct costs of FS every 5 years for those over 50 including the colonoscopies this would generate are $3 to $4 million.