TY  - JOUR
T1  - PRedicting advanced proximal colonic neoplasia with
screening sigmoidoscopy
AU  - Levin TR, Palitz A, Grossman S, et al
Y1  - 1999/05/05
N1  - 10.1001/jama.281.17.1611
JO  - JAMA
SP  - 1611
EP  - 1617
VL  - 281
IS  - 17
N2  - Context 
                  Indications are not well defined for follow-up
colonoscopy for all patients with distal colonic tubular adenomas (TAs)
found at screening sigmoidoscopy.Objective 
                  To determine whether distal adenoma size, number, and
villous histology, along with family history and age, are predictors of
advanced proximal colonic neoplasia.Design 
                  Cross-sectional analysis conducted between January 1, 1994,
and December 31, 1995.Setting 
                  Large group-model health maintenance organization in
northern California.Patients 
                  A total of 2972 asymptomatic subjects aged 50 years or
older undergoing colonoscopy as follow-up to a screening sigmoidoscopy.Main Outcome Measure 
                  Based on sigmoidoscopy, colonoscopy, and
pathology reports, occurrence of advanced proximal neoplasia, defined
as adenocarcinoma or TAs 1 cm or larger or with villous features or
severe dysplasia located beyond sigmoidoscopic view.Results 
                  The prevalence of advanced proximal neoplasia was
similar among patients with no TAs at sigmoidoscopy, those with TAs
less than 1 cm in diameter, and those with TAs 1 cm in diameter or
larger (prevalence, 5.3%, 5.5%, and 5.6%, respectively). Of patients
with a distal tubulovillous or villous adenoma, 12.1% had advanced
proximal neoplasia. In multivariate analyses, having a distal
tubulovillous adenoma or villous adenoma was the strongest predictor of
advanced proximal neoplasia (odds ratio, 2.30; 95% confidence
interval, 1.69-3.14). Age of 65 years or older, having more than 1
adenoma, and a positive family history of colorectal cancer were also
significant predictors. Distal adenoma size was not a significant
predictor in any multivariate analyses.Conclusions 
                  Advanced proximal neoplasia is not uncommon in
subjects with or without distal TAs, but subjects with advanced distal
histology and those older than 65 years are at increased risk.
Age-specific screening using sigmoidoscopy starting at ages 50 to 55
years and colonoscopy after age 65 years may be justified.
SN  - 0098-7484
M3  - doi: 10.1001/jama.281.17.1611
UR  - http://dx.doi.org/10.1001/jama.281.17.1611
ER  -