We read with great interest the letter of Steinert and colleagues (Gut 2005;54:1045–6). They described disseminated epithelial cells in the bone marrow of patients with colorectal adenomas. As adenomas are non-cancerous, it is questionable whether these epithelial-like cells really represent disseminated cancer cells. If so, the benign nature of intraepithelial neoplasia is basically challenged.

The search for micrometastatic disease in the bone marrow of cancer patients is an intriguing field in which many different diagnostic molecular modalities are being explored. However, the clinical impact of bone marrow micrometastatic disease is not clear. Patients with breast cancer frequently develop clinically manifest bone marrow metastases and in these patients …