Adenomas and hyperplastic polyps in screening studies

Abstract

Abstract A survey is given of colorectal polyps detected in a prospective randomized screening study with the fecal occult blood test. It is demonstrated that colonoscopy in persons with positive Hemoccult‐II tests results in detection of and removal of a higher number of adenomas than among controls. The strategy may, therefore, possibly be followed by a reduction of the incidence of colorectal cancer. Screen‐detected adenomas were most often in males and were larger than among controls; they were most often in the sigmoid colon, whereas the rectum was the most frequent location for adenomas in controls. Eight percent of persons with screen‐detected adenomas had some symptoms, which could be referred to adenomas, in contrast to 50% among controls . Hyperplastic polyps served as markers for adenomas in persons with positive Hemoccult‐II as well as in controls with adenomas detected by colonoscopy; however, most persons with adenomas had no hyperplastic polyps . Endoscopic polypectomy did not result in any severe complications, but surgical removal in 2 of 22 patients proved fatal . The results presented are compared with those of other prospective randomized trials. The optimistic view—that the incidence of cancer may be reduced by polypectomy in persons with positive Hemoccult‐II tests—stresses the importance of securing optimal colonoscopy service .