Should we forget about rectosigmoidoscopy for the diagnosis of advanced colorectal neoplasia?

¿Debemos olvidar la rectosigmoidoscopia para el diagnóstico de neoplasia avanzada colorrectal? There is a rising trend in colorectal cancer worldwide and despite the advances in medicine and the fact that the important risk factors of age above 50 years, male sex, a family history of the disease, smoking, obesity, and diabetes mellitus are recognized, it has not been possible to determine a factor in the general population that can identify with absolute certainty the population at risk for developing this neoplasia. 1 In the year 2002 in Mexico, a total of 108,064 new cases of cancer with histopathologic diagnoses 2 were registered. Of that total, 3,791 (3.5%) cases corresponded to colorec-tal cancer, specifically 2.3% to cancer of the colon and 1.2% to cancer of the rectum, situating colorectal cancer among the first 10 causes of morbidity due to malignant neoplasias. In 2006, 3 4,550 new cases (4.19%) were reported, 2.80% of which corresponded to cancer of the colon and 1.39% to cancer of the rectum, showing that there is also an increasing trend of this neoplasia in our country. The majority of cases of colorectal cancer (CRC) derive from adenomatous polyps and new cases can be prevented and/or reduced through the detection and removal of those polyps through colonoscopy. Survival can also increase if CRC is diagnosed in the early stages of the disease. However, not all adenomas present with the same risk for transforming into cancer. Tw o risk groups are currently distinguished based on their transformation probability, and they are classified as low-risk and high-risk adenomas. The low-risk category is defined as 1 or 2 adenomas smaller than 10 mm. a neoplasia avanzada colorrectal en el Policlínico Peruano Japonés. Adenomas are considered high-risk when they are larger than 10 mm or there are 3 or more polyps, when there is a villous component, or there is the presence of high grade dysplasia. The same associated factors have been described for both CRC and advanced neoplasia (AN), given that the precise factors related to the latter are not known. The study by Parra-Pérez et al. 4 evaluated the factors associated with AN and proximal AN (PAN) in colorectal cancer in a Latin American population. They conducted an observational, cross-sectional analysis that included 846 patients. AN was detected in 108 of the patients and PA N in 55. The most striking fact for the authors was that of those 55 …