He then moved on to discuss polypectomy to reduce incidence as another form of secondary prevention of colorectal cancer, as adenomatous polyps are precursors to cancer. Researchers more recently have found that the polyp is preceded by an aberrant crypt. The adenoma develops into carcinoma over a very long period of time, and because the technology allows doctors to detect very small polyps, there is a large window of opportunity for prevention. The National Polyp Study showed that a good colonoscopy at time zero is extremely effective in clearing out the colon of significant pathology. Patients at higher risk of developing cancer are those with multiple adenomas and a positive family history.
Age also is an important factor because people tend to develop more adenomas with age.
Dr. Winawer reported that several trials are either under way or have been completed to study the application of colonoscopy screening to the general population as a viable approach to the ultimate eradication of colorectal cancer in the United States. Currently, the National Colonoscopy Screening Trial is being planned and aims to identify in the general population people at risk for advanced adenomas in order to reduce colon cancer mortality by reducing incidence. This coverage includes fecal occult blood, flexible sigmoidoscopy, and colonoscopy. The objectives are to inform people over the age of 50 about benefits of CRC screening, motivate this group to talk to their health care provider about the CRC screening program, and promote Medicare's new CRC screening benefits. He then distributed an educational handout for attendees to give to family members to inform them of the importance of early detection.