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Authors’ Response: Acromegaly and Colorectal Cancer—Risk Assessment Should Be Based on Population-Based Studies^d

Department of Endocrinology, St. Bartholomew’s Hospital, West Smithfield, London EC 1A 7BE, United Kingdom

To the editor:

We firmly believe that acromegaly does indeed constitute a high-risk group for the development of colorectal neoplasia. It has been clearly shown. Over the last decade, there have been a large number of prospective studies of the prevalence of colorectal neoplasia in acromegaly at colonoscopic screening, including one by Renehan et al. in which they actually reported three asymptomatic patients in whom a cancer was detected. Among such studies, the optimum comparison must surely be the simultaneous screening of asymptomatic nonacromegalic subjects, and a combined comparison of the data from all series using these control groups gives a relative risk of colon cancer in acromegaly of more than 13-fold. Although it is certainly true that there is variability in colonoscopic completion rates, the increased bowel length and colonomegaly in acromegaly, as recently reported by Renehan et al. makes incomplete examination more likely to occur in acromegaly with potential underestimation of neoplastic prevalence. The use of population-based studies in acromegaly is fundamentally flawed, because all of the three quoted by the author have relied on retrospective data acquired over long periods. It has become quite clear to clinical endocrinologists over the last decade that the morbidity associated with acromegaly has changed and that patients are surviving significantly longer due to the more aggressive and effective treatment of the cardiovascular and metabolic complications. Our data and data of other groups show that colonic neoplasia in acromegaly is an age-dependent complication, and therefore it is only now that patients are surviving long enough to develop this complication. Comparative data must be acquired recently.

The potential benefits of detecting occult neoplasia in these patients clearly and firmly outweigh the theoretical risks. We have not encountered a single complication in over 400 procedures on our patients with acromegaly. We encourage all endocrinologists to accept the data derived from clinical observation rather than theoretical calculation and to ensure that all patients with acromegaly under their care receive appropriate colonoscopic screening.

Footnotes

^d Address all correspondence to: Paul Jenkins, M.D., Department of Endocrinology, St. Bartholomew’s Hospital, West Smithfield, London EC 1A 7BE, United Kingdom.

Received December 27, 2001.

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