Gastroenterologia/Proctologia/Fígado Colonoscopia é uma ferramenta eficaz para o screening de carninomas colorretais em mulheres

21/06/2005

Artigo publicado na New England Journal of Medicine traz um estudo da eficácia da colonoscopia como método de screening para carcinomas (CA) colorretais em mulheres.   Pesquisadores norte-americanos utilzaram como dados de comparação o estudo Veterans Affairs Cooperative Study 380 (VA) que demonstrou que neoplasias colorretais avançadas como, por exemplo, adenomas de pelo menos 1 cm de diâmetro, adenomas vilosos ou adenomas com alto grau de displasia podem não ser diagnosticados em homens através de sigmoidoscopia flexível, mas detectados através de colonoscopia.   Para a determinação da prevalência e localização de neoplasias avançadas, foi oferecido o exame de colonoscopia a pacientes assintomáticas que tinham indicação de screening para CA de cólon e reto. A "capacidade" diagnóstica da sigmoidoscopia flexível foi calculada estimando-se a proporção de pacientes com neoplasia avançada cujas lesões seriam identificadas se fosse realizada apenas sigmoidoscopia flexível.   As lesões foram consideradas detectáveis por sigmoidoscopia flexível se estivessem presentes no cólon distal ou se elas estivessem no cólon proximal conjuntamente com lesões no cólon distal, já que lesões em cólon distal indicam a necessidade de uma colonoscopia.   Os resultados foram comparados aos de pacientes com exame de fezes ocultas negativo e sem histórico familiar para CA de cólon do estudo VA com ajuste de idade.   A colonoscopia foi realizada em 1.463 mulheres sendo que 230 delas (15,7% do total) apresentavam história familiar para CA cólon. A colonoscopia revelou neoplasia avançada em 72 mulheres (4,9%). Se apenas o exame de sigmoidoscopia fosse realizado, o diagnóstico teria sido realizado em apenas 25 destas pacientes (1,7% do total), deixando de fora 47 pacientes (3,2%).   Apenas 35,2% das mulheres com neoplasia avançada teriam seu diagnóstico realizado se tivessem se submetido apenas à sigmoidoscopia flexível, enquanto nos homens esta taxa seria de 66,3% quando utilizados dados do estudo VA.   O estudo concluiu que a a colonoscopia pode ser utilizada como screening para CA colorretal também em mulheres. Colonoscopic Screening of Average-Risk Women for Colorectal Neoplasia - NEJM - Volume 352:2061-2068 May 19, 2005 Number 20 HOME   |   SEARCH   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   HELP Please sign in for full text and personal services   Previous Volume 352:2061-2068 May 19, 2005 Number 20 Next Colonoscopic Screening of Average-Risk Women for Colorectal Neoplasia Philip Schoenfeld, M.D., Brooks Cash, M.D., Andrew Flood, Ph.D., Richard Dobhan, M.D., John Eastone, M.D., Walter Coyle, M.D., James W. Kikendall, M.D., Hyungjin Myra Kim, Sc.D., David G. Weiss, Ph.D., Theresa Emory, M.D., Arthur Schatzkin, M.D., David Lieberman, M.D., for the CONCeRN Study Investigators   Full Text PDF PDA Full Text PowerPoint Slide Set Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Find Similar Articles PubMed Citation

Background Veterans Affairs (VA) Cooperative Study 380 showed that some advanced colorectal neoplasias (i.e., adenomas at least 1 cm in diameter, villous adenomas, adenomas with high-grade dysplasia, or cancer) in men would be missed with the use of flexible sigmoidoscopy but detected by colonoscopy. In a tandem study, we examined the yield of screening colonoscopy in women.

Methods To determine the prevalence and location of advanced neoplasia, we offered colonoscopy to consecutive asymptomatic women referred for colon-cancer screening. The diagnostic yield of flexible sigmoidoscopy was calculated by estimating the proportion of patients with advanced neoplasia whose lesions would have been identified if they had undergone flexible sigmoidoscopy alone. Lesions were considered detectable by flexible sigmoidoscopy if they were in the distal colon or if they were in the proximal colon in patients who had concurrent small adenomas in the distal colon, a finding that would have led to colonoscopy. The results were compared with the results from VA Cooperative Study 380 for age-matched men and women with negative fecal occult-blood tests and no family history of colon cancer.

Results Colonoscopy was complete in 1463 women, 230 of whom (15.7 percent) had a family history of colon cancer. Colonoscopy revealed advanced neoplasia in 72 women (4.9 percent). If flexible sigmoidoscopy alone had been performed, advanced neoplasia would have been detected in 1.7 percent of these women (25 of 1463) and missed in 3.2 percent (47 of 1463). Only 35.2 percent of women with advanced neoplasia would have had their lesions identified if they had undergone flexible sigmoidoscopy alone, as compared with 66.3 percent of matched men from VA Cooperative Study 380 (P<0.001).

Conclusions Colonoscopy may be the preferred method of screening for colorectal cancer in women.

Source Information

From the Division of Gastroenterology, University of Michigan School of Medicine and Veterans Affairs Center for Excellence in Health Services Research, Ann Arbor (P.S.); the Division of Gastroenterology, Uniformed Services University of Health Sciences, Bethesda, Md. (P.S., B.C., R.D., J.E., W.C., J.W.K.); the Division of Gastroenterology, National Naval Medical Center, Bethesda, Md. (B.C., J.E.); the Division of Epidemiology, University of Minnesota, Minneapolis (A.F.); the Division of Gastroenterology, Naval Medical Center, San Diego, Calif. (R.D., W.C.); the Division of Gastroenterology, Naval Medical Center, Portsmouth, Va. (R.D., W.C.); the Division of Gastroenterology, Walter Reed Army Medical Center, Washington, D.C. (J.W.K.); the Center for Statistical Consultation and Research and the Department of Biostatistics, University of Michigan, Ann Arbor (H.M.K.); the Department of Biostatistics, Veterans Affairs Medical Center, Perry Point, Md. (D.G.W.); the Armed Forces Institute of Pathology, Washington, D.C. (T.E.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Md. (A.S.); and the Division of Gastroenterology, Oregon Health Sciences University and Veterans Affairs Medical Center, Portland (D.L.).

Address reprint requests to Dr. Schoenfeld at VAMC 111-D, 2215 Fuller Rd., Ann Arbor, MI 48105, or at pschoenf@umich.edu .