Sanford D. Markowitz, MD, PhD; Steven H. Itzkowitz, MD; Barry M. Berger, MD
Potential Financial Conflicts of Interest:Employment: B.M. Berger (EXACT Sciences). Grants received: S.H. Itzkowitz (EXACT Sciences). Patents received: S.D. Markowitz (EXACT Sciences).
Markowitz SD, Itzkowitz SH, Berger BM. The Effectiveness of Colonoscopy in Reducing Mortality From Colorectal Cancer. Ann Intern Med. 2009;150:816-817. doi: 10.7326/0003-4819-150-11-200906020-00013
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Published: Ann Intern Med. 2009;150(11):816-817.
TO THE EDITOR:
The recent study by Baxter and colleagues (1) highlights that although colonoscopic screening decreases death rates from colon cancer, it has limitations, particularly with respect to preventing deaths from cancer of the right colon. Baxter and colleagues suggest that these limitations might reflect the technical difficulty of routinely reaching and identifying right-sided colonic lesions, which may be flat and harder to visualize or might have a different biology from more distal cancer. Indeed, it is well established, for example in the context of the Lynch syndrome, that colon cancer with microsatellite instability, which predominantly appears in the right colon, develops at an accelerated rate and can appear sometimes within 12 to 24 months of previously normal colonoscopies. The more common types of nonfamilial microsatellite instability colon cancer are also likely to easily give rise to “interval” colon cancer, appearing between screening colonoscopies.
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