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Using Risk for Advanced Proximal Colonic Neoplasia To Tailor Endoscopic Screening for Colorectal Cancer

Thomas F. Imperiale, MD; David R. Wagner, MS; Ching Y. Lin, BS; Gregory N. Larkin, MD; James D. Rogge, MD; and David F. Ransohoff, MD
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From Indiana University School of Medicine, Indiana University, Roudebush Veterans Affairs Medical Center, The Regenstrief Institute, Inc., Indianapolis Gastroenterology Research Foundation, and Eli Lilly and Co., Inc., Indianapolis, Indiana; and University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.

Grant Support: In part by grant K24 DK 02756 from the National Institute of Diabetes and Digestive and Kidney Disorders (Dr. Imperiale).

Potential Financial Conflicts of Interest: At the time of data collection, Mr. Wagner was responsible for the Indianapolis Gastroenterology Research Foundation portion of the Eli Lilly colorectal cancer program, and a portion of his salary was paid by funds received from Lilly for program management.

Requests for Single Reprints: Thomas F. Imperiale, MD, The Regenstrief Institute, Inc., 1050 Wishard Boulevard, Indianapolis, IN 46202.

Current Author Addresses: Dr. Imperiale: The Regenstrief Institute, Inc., 1050 Wishard Boulevard, Indianapolis, IN 46202.

Ms. Lin: 6931 Middlebranch Avenue, Canton, OH 44721.

Dr. Rogge: Indianapolis Gastroenterology Research Foundation, 8051 South Emerson 200, Indianapolis, IN 46237.

Dr. Ransohoff: CB 7080, 4103 Bioinformatics Building, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080.

Mr. Wagner: Med Institute, 1400 Cumberland Avenue, West Lafayette, IN 47906.

Dr. Larkin: Eli Lilly and Co., Lilly Corporate Center, DC 2111, Indianapolis, IN 46285.

Author Contributions: Conception and design: T.F. Imperiale, D.R. Wagner, D.F. Ransohoff.

Analysis and interpretation of the data: T.F. Imperiale, D.R. Wagner, C.Y. Lin, D.F. Ransohoff.

Drafting of the article: T.F. Imperiale, D.F. Ransohoff.

Critical revision of the article for important intellectual content: T.F. Imperiale, D.R. Wagner, G.N. Larkin, J.D. Rogge, D.F. Ransohoff.

Final approval of the article: T.F. Imperiale, J.D. Rogge, D.F. Ransohoff.

Provision of study materials or patients: D.R. Wagner, G.N. Larkin, J.D. Rogge.

Statistical expertise: T.F. Imperiale.

Obtaining of funding: T.F. Imperiale.

Administrative, technical, or logistic support: D.R. Wagner, C.Y. Lin, G.N. Larkin.

Collection and assembly of data: T.F. Imperiale, D.R. Wagner, C.Y. Lin.

Ann Intern Med. 2003;139(12):959-965. doi:10.7326/0003-4819-139-12-200312160-00005
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The finding that sigmoidoscopy alone may fail to detect between 40% and 50% of advanced proximal neoplasms has led to calls for universal colonoscopy (12). However, the feasibility of this strategy may be limited by cost; safety; resource constraints; and an uncertain incremental benefit of colonoscopy on meaningful patient outcomes, such as mortality and quality of life (9). Although periodic sigmoidoscopy is recommended as an acceptable and equally preferred option among several tests, it is unclear in which patients sigmoidoscopy alone may be considered especially suitable. Some investigators have suggested that the intensity of testing be tailored to a person's risk (2326), but tailoring cannot effectively be done without detailed information about risk.

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Summary for Patients

Using Risks To Tailor Screening for Colorectal Cancer

The summary below is from the full report titled “Using Risk for Advanced Proximal Colonic Neoplasia To Tailor Endoscopic Screening for Colorectal Cancer.” It is in the 16 December 2003 issue of Annals of Internal Medicine (volume 139, pages 959-965). The authors are T.F. Imperiale, D.R. Wagner, C.Y. Lin, G.N. Larkin, J.D. Rogge, and D.F. Ransohoff.


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