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Only half of proximal colon cancers are associated with adenomas in the distal colon. This has important implications for the selection of the initial investigation for colorectal cancer screening
Of all the common cancers, colorectal cancer is the best suited to prevention through screening as it is derived from benign adenomas which can be easily detected and removed. The best screening investigation remains much debated. Many argue that colonoscopy is superior to other techniques because it has the highest sensitivity (>90%) and examines the whole colon.1 However, it has a number of important disadvantages. Firstly, it is potentially dangerous. Perforation rates of 1 in 1000–1 in 20 000 have been found in large studies from the USA and Germany.2,3 Colonoscopy is also expensive and requires highly skilled operators who are in short supply.4 For these reasons investigators have sought a screening strategy that reduces the number of colonoscopies undertaken. A study from St Mark’s Hospital of the long term risk of colorectal cancer in patients with rectosigmoid adenomas found that 88% of cancers developed …