CA: A Cancer Journal for Clinicians, Vol 28, 211-217, Copyright
© 1978 by American Cancer Society
Proctosigmoidoscopy in Asymptomatic Men: A 24-Month Study
Paul C. Morton M.D., F.A.C.S.1
1 Consulting Surgeon, St. Luke's Hospital Center, New York, New York.
One criterion in any health screening program lies in the detection of precancerous and early cancerous lesions. Proctosigmoidoscopic examination lends itself well to meeting this criterion for cancer of the colon and rectum. But this examination is more than a simple instrumentation procedure; therefore, identification of the high risk patient of any age is an essential element of making the best use of this examination.
If only those patients over 40 or 50 years of age are included in routine proctosigmoidoscopic examination, many lesions will go undetected, in this younger age group, until it is too late for the prevention or cure of cancer. The percentages of patients with polyps and with a history of polyps illustrate the need to place these individuals in a more aggressive screening program.
If manpower and economic considerations are to determine examination policy, then an initial proctosigmoidoscopic examination for all patients of any age should be performed. Those found to be at risk for colon and rectal cancer can be entered into a comprehensive screening program; those identified to be low risk patients can be maintained in a lower profile program tempered with clinical judgement. Annual six-slide Hemoccult testing in those under 40 who are at low risk may have merit.
For those patients who are resistant to having proctosigmoidoscopy, a gentle but straightforward explanation of the benefits involved may be sufficient inducement.
It is emphasized that no single procedure or test is all-encompassing; rather, digital and proctosigmoidoscopic examination, Hemoccult testing, barium enema with air contrast and colonoscopy are all complementary. The importance of taking a thorough history cannot be emphasized enough. Moreover, a truly informative picture is more likely to be obtained through a verbal exchange than by a written "checklist."
It seems wise, based on current data, to incorporate therapeutic considerations into a screening program. As mentioned, these lesions should not be regarded lightly due to their potentially sinister character; furthermore, small polyps are often difficult to locate by a subsequent examiner.
(The Life Extension Institute is purely a screening facility and no treatment procedures are undertaken. Therefore, in this paper there has been no mention of the pathology of the lesions discovered in these patients.
No statistics are given for the diagnosis of cancer of the rectum in either gross lesions or polyps. Most examinees are returned to their own physician who directs the course of treatment. Accurate diagnosis and adequate follow-up information are not available. The response to follow-up betters sent three months after the examination has been 43 percent. This is sometimes a note from the examinee, a letter from the physician, or a response from the surgeon with or without a pathological report. Under these circumstances such statistics are not valid. We prefer to emphasize the preventive character of the program. The question is not how many cancers have been found but rather how many cancers have been prevented.)
In summary, the identification of risk patients—regardless of their ages—and their routine examination for presence of polyps would seem a more rational approach to the question of who should or should not have proctosigmoidoscopy than is our present practice of defining need simply according to age.
