Colorectal cancer(CRC) is the 2nd leading cause of cancer death in Australia following lung cancer. CRC will develop in 5-6% of the adult population without family history and half will die as a consequence. Hence the importance for screening for CRC. Following table summarises risk groups and screening methods.
There is increasing use of warfarin and antiplatelet agents in the aging population for various indications. These patients are often referred for endoscopy for investigation of abdominal pain, dyspepsia, change of bowel habit, family history of bowel cancer, positive faecal occult blood, anaemia, polyp surveillance etc.
While colonoscopy and polypectomy reduced incidence of bowel cancer in 76% and reduced bowel cancer related mortality in 53% in a cohort of post-polypectomy pa- tients ( National bowel cancer study), the magnitude of such prevention depends on your colonoscopist’s adenoma detection rate (ADR). Colonoscopist’s ADR is de- fined as the percentage of consecutive screening (asymptomatic) patients who had at least one adenoma removed. A colonoscopist’s ADR is inversely proportional to post-colonoscopy missed cancers and adenomas. Higher the ADR less the missed colorectal cancers (CRC) and polyps (adenomas) for these patients in the post – polypectomy years.