Dr. Holt will present these data on Tuesday, May 22 at noon PT in Halls C-G of the San Diego Convention Center.

First Time Colonoscopy in the Elderly Yields a High Rate of Curable Colorectal Cancer (Abstract #728)

Colonoscopy finds a high rate of colorectal cancer (CRC) in elderly patients who had not been previously screened, according to new research from Spectrum Health, Grand Rapids, MI. Because of the considerable variation in health and functionality among elderly individuals, investigators led by Therese G. Kerwel, MD, research fellow at Grand Rapids Medical Education Partners/Spectrum Health, sought to determine cancer detection rates in the elderly undergoing outpatient colonoscopy. The results were stratified according to when the most recent colonoscopy was performed.

Researchers identified 903 outpatient exams in elderly patients over a two-year period. They looked at why these individuals were undergoing colonoscopy and assessed results for cancer diagnoses. Investigators found that elderly patients who had never previously undergone a colonoscopy had a cancer rate of 9.4 percent, which was significantly higher than those who had previously undergone colonoscopy. Furthermore, the patients with identified CRC all underwent curative surgery. The cancers had not yet metastasized, making screening even more important, Dr. Kerwel said.

“It is worthwhile to offer a screening colonoscopy for elderly patients in good health and functional status who have never previously undergone the test,” Dr Kerwel said. She added that to address efficient utilization of resources along with costs, instead of completely stopping screening, providers should consider reducing the number of surveillance exams in this population since these had very low yield for detection of cancer, and the detection of polyps in this population is of questionable significance.

The use of screening colonoscopy in the elderly has become controversial in recent years with the U.S. Preventive Services Task Force recommendation against routine screening in adults aged 76 to 85. The task force has determined that the risks outweigh the benefits and that the life years saved by screening this population become so reduced that it does not justify the risk. Additionally, a lack of Medicare reimbursement has served as a financial disincentive to screen elderly patients.

Dr. Kerwel will present these data on Monday, May 21 at 2:21 p.m. PT in 28ab, San Diego Convention Center.

Should Diabetes Mellitus be an Indication for Earlier Colorectal Cancer Screening? (Abstract #Tu1185)

A new study from the Washington University School of Medicine, St. Louis, MO, suggests that patients with diabetes mellitus type II (DM) should be screened for colorectal cancer (CRC) at younger ages than is usually recommended. While DM, which occurs when there are excess levels of insulin in the blood, is associated with increased risk of colorectal neoplasia (new tissue that results in the formation and growth of a tumor), there are currently no modifications in current screening guidelines for individuals with DM.

Investigators led by Hongha T. Vu, MD, clinical gastroenterology fellow, Washington University, sought to determine if patients with DM should be screened earlier than patients at average risk for CRC. They found that the presence of adenomas among those screened between the ages of 40 and 49 with DM was about the same as those screened between the ages of 50 and 59 without DM. While many studies show an association between diabetes and CRC and polyps, this is the first study to show adverse risk in younger patients demonstrating that they should undergo screening earlier.

“We concluded that those with diabetes may require early screening because they have a similar risk of colon cancer and precursor adenomas as older non-diabetics who are currently recommended to start screening at age 50,” said Dr. Vu.

Researchers performed a retrospective cohort study of patients undergoing colonoscopy over a six-year period and compared three age groups matched for date of exam and gender: ages 40 to 49 with DM, ages 40 to 49 without DM, and ages 50 to 59 without DM.

Dr. Vu cautioned that because the study was not prospective, investigators cannot say with certainty that diabetes is by itself a risk factor. Other risk factors overlap, such as obesity, diet and smoking. She added that the public health implications are significant since approximately 23 million Americans have diabetes, and that number is expected to double in the next 25 years.

No pharmaceutical funding was provided for this study.

Dr. Vu will present these data on Tuesday, May 22 at noon PT in Halls C-G of the San Diego Convention Center.

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DDW is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 19??, 2012, at the San Diego Convention Center. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.

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Amy Levey
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Digestive Disease Week