Screening colonoscopy among persons 50 to 60 years of age with and without familial risk of colorectal cancer - a prospective multicenter trial

Background: In Germany screening colonoscopy was introduced into the National program on colorectal cancer prevention in Oktober 2002. The prevalence of neoplasia in patients with and without familiar risk was determined together with patient satisfaction with screening colonoscopy. Methods: Asymptomatic subjects from 50 to 60 years underwent screening colonoscopy and were stratified in two groups with and without familiar risk (first-degree relatives with CRC) in a multicenter trial among German gastroenterologists. Advanced neoplasia was defined as an adenoma at least 1 cm in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. After recovery from sedation all subjects were asked if they would agree to a control colonoscopy and the pain score was recorded on a scale from 0 to 6. Results: A total of 557 subjects (322 at average risk and 235 with familiar risk) underwent screening colonoscopy. The prevalence of advanced neoplasia in subjects without/with familiar risk was not significantly different in persons from 50 to 54 years (9 vs. 15%) in contrast to persons from 55 to 60 years (10 vs. 22%, p=0.004) where the relative risk was doubled. Compared to younger patients, the prevalence of all neoplasia (including small adenomas) was significantly different only for older patients with familiar risk (44 vs. 23%, p < 0.0001). The mean value of the pain-score was 0.76 + 1.0. Subjects examined without medication had significantly higher pain scores than subjects under medication. Colonoscopy performed under disoprivan resulted in similar pain-scores compared to midazolam at dosages > 5 mg. All patients agreed to a control colonoscopy. Conclusion: Screening colonoscopy is an effective and well-accepted method. The high prevalence of advanced neoplasia even in persons from 50 to 54 years suggests that screening should start at the age of 50.