Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Schoen and colleagues1 acknowledged that some of the "new" lesions discovered
at 3 years were found because of increased depth of insertion or better bowel
preparation at the second examination. Data from the Veterans Affairs (VA)
Cooperative Study2 suggest that if a greater
amount of the colon is examined at sigmoidoscopy, the yield can be improved.
In the VA study,2 we performed screening
colonoscopy in 3121 asymptomatic persons, aged 50 to 75 years. We reported
differences in sigmoidoscopy yield based on extent reached, and found that
188 of 3121 patients (6.0%) had advanced neoplasia or cancer in the rectum
and sigmoid colon. When the examination reached the splenic flexure, 228 patients
(7.3%) were found to have distal advanced neoplasia. Overall, 329 patients
(10.5%) had at least 1 advanced lesion in the colon. These data suggest that
if more colon is examined at sigmoidoscopy, more advanced pathology is found.
These conclusions are reinforced by the Norwegian Colorectal Cancer Prevention
study (NORCCAP).3 All these data demonstrate
that sigmoidoscopy is an effective, but imperfect, screening tool. Most, but
not all, serious pathology can be detected using sigmoidoscopy.2,4 This
may be the best that we can expect from sigmoidoscopy in practice.
Sonnenberg A, Lieberman D. Optimal Intervals and Techniques for Screening SigmoidoscopyOptimal Intervals and Techniques for Screening Sigmoidoscopy. JAMA. 2003;290(16):2122-2123. doi:10.1001/jama.290.16.2122-a