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Can Mortality from Colorectal Cancer Be Reduced?

Physicians and other health-care personnel who treat patients with metastatic and fatal colorectal cancer have been seeking ways to advance early detection and, as a consequence, ensure improved survival, reduced mortality, and a better quality of life. While the concepts and technology are currently available to fulfill these clinical goals, their effectiveness has been debated and not uniformly accepted. Recent evidence indicates that the available concepts and technology can reduce the mortality from colorectal cancer, thus validating the large body of data that has accumulated during the past two decades that has consistently suggested this benefit.' Strategies that provide an opportunity for reducing the mortality from colorectal cancer may be categorized into (i) the primary prevention of neoplasia by dietary and life-style modification, (ii) detection of early stage curable cancer, and ( 5 ) prevention of cancer by identification and removal of the precursor adenomatous polyp. Primary prevention concepts and data are discussed by others at this conference. The concept of the early detection of colorectal cancer had been dormant until developments beginning in the late 1960s and extending into the early 1970s provided the technical means by which this concept could be implemented clinically. These developments included the introduction of the impregnated guaiac slide colonoscopy, and colonoscopic polype~tomy.~ These techniques followed the evolution of surgical oncologic principles5 and the clearer demonstration of the adenoma as the precursor lesion.6