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Saving lives on the road to discovery
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William I. Wolff, MD, who will be remembered in the history of modern medicine as the co-developer of colonoscopy, died at age 94 in late August. Back in the 1960s, Dr. Wolff was working with Hiromi Shinya, MD, to probe the full length of the colon using a tube with electronic sensors. Their most significant advance was a device designed by Shinya in collaboration with Olympus Optical Company — a wire loop snare-cautery that enabled physicians to remove a polyp immediately, making a second procedure unnecessary.
Landmark study
From June 1969 to June 1972, Dr. Wolff and colleagues performed more than 1,600 diagnostic colonoscopies with minimal to no reported complications. By that time, 303 polyps were removed from 218 patients. Their landmark findings, published in The New England Journal of Medicine in 1973, suggested that colonoscopy had therapeutic applications, in that colonic polyps beyond the reach of the conventional sigmoidoscope could be removed effectively and safely using their snare-electrocautery technique. This quick and relatively simple discovery eventually eliminated the need for laparotomy that had been previously used to distinguish between benign and malignant polyps.
Later that year, Drs. Wolff and Shinya wrote a review of 499 polypectomies in “A New Approach to Colonic Polyps” in the Annals of Surgery. Their major conclusion from the research included the fact that fiberoptic colonoscope makes all parts of the colon endoscopically accessible, and that endoscopic polypectomy can be achieved with a high degree of safety.
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In 1999, the journal Seminars in Colon and Rectal Surgery considered Drs. Wolff’s and Shinya’s published results in The New England Journal of Medicine as one of the 20th century’s dozen landmark articles in the field. Throughout the years, colonoscopy has helped identify patients who have colorectal cancer, manage patients with ulcerative colitis and Crohn’s disease, and most critically, prevent colorectal cancer by finding and removing polyps.
Colorectal cancer is a global public health problem that is diagnosed in more than 1.2 million patients each year, causing more than 600,000 deaths. A number of guidelines and provider surveys strongly support the use of colonoscopy as the optimal screening test. The ACS “Guidelines for the Early Detection of Cancer” recommend, beginning at age 50 years, both men and women follow testing schedules for screening to find colon polyps and cancer. Colonoscopy has become the gold standard for providing a diagnostic test and, with polypectomy, a therapeutic intervention that can help prevent cancer. In 2011, a study published in
Annals of Internal Medicine showed that in patients who had colonoscopy in the previous 10 years, the risks for early and more advanced stages of cancer were reduced by more than 50%. A lower risk for colorectal cancer was seen for cancer on both sides of the colon.
Clear benefits of screening
On July 5, the CDC released a report suggesting the rates of adults developing and dying of colorectal cancer are decreasing. In the United States, the rate of new cases of colorectal cancer decreased from 52.3/100,000 patients in 2003 to 45.4/100,000 patients in 2007, representing 66,000 fewer cancers, while the death rate decreased from 19/100,000 patients to 16.7/100,000 patients, representing 32,000 fewer deaths. The report also finds the rate of cancer screening increased overall, from 52% in 2002 to 65% in 2010. This suggests colorectal cancer can be prevented or cured when diagnosed as early as possible. Besides adding longevity, screening procedures will lead to healthier and more productive lives and will cut down on the increasing health care costs associated with the treatment of colon cancer.
Despite the revolution started in the 1960s by Dr. Wolff and colleagues, one of three people aged 50 to 75 years still are not undergoing screening for colorectal cancer. Making colonoscopy more available for diagnosis and surveillance is crucial for the success of any screening program. In conclusion, Dr. Wolff, along with Dr. Shinya, always will be remembered in the history of modern medicine as pioneers who helped reduce the risk and mortality for colorectal cancer through the development of lifesaving medical tools.
Tanios Bekaii-Saab, MD, is medical director of gastrointestinal oncology, and associate professor of medicine and pharmacology at The Ohio State University – James Cancer Hospital. He is also a member of the HemOnc Today Editorial Board. Disclosure: Dr. Bekaii-Saab reports no relevant financial disclosures.
For more information:
- Brenner H. Ann Intern Med. 2011;154:22-30.
- www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer. Accessed Oct. 25, 2011.
- Hoffman RM. Expert Rev Anticancer Ther. 2011;11: 561-569.
- Wolff WI. Ann Surg. 1973;178:367-378.
- Wolff WI. N Engl J Med. 1973;288:329-332.
- Wolff W and Shinya H. Polypectomy via the Fiberoptic Colonoscope-Removal of Neoplasms Beyond Reach of the Sigmoidoscope Seminars in Colon and Rectal Surgery 1999, VOL 10; PART 4, pages 247-252.
- CDC. Vital Signs: Colorectal Cancer Screening, Incidence, and Mortality --- United States, 2002—2010 July 8, 2011 ; 60(26); 884-889.