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Dr. William Wolff and the Colonoscopy: Making a Difference that Saves Lives
The physician who radically changed the diagnosis and treatment of colorectal cancer (CRC) died at age 94 on August 20th in Manhattan, New York.  Dr. William Wolff was the co-developer of one of the most important tools used in the detection of established CRC and the pre-cancerous lesions potentially leading to cancer: the colonoscopy (Martin, 2011). 


The colonoscopy is now established as a standard of care for the screening of CRC; the procedure is able to visualize the entire five feet of the colon, reflecting the image seen by the colonoscope to the practitioner.   Screening with the colonoscope can detect advanced neoplasms of the colon in patients without symptoms; many of these lesions would not be able to be detected with other procedures, such as sigmoidoscopy (Lieberman, et al. 2000).  Procedures performed prior to the colonoscope were limited in access as only about ten inches could be seen before blocked (Martin, 2011).  Dr. Wolff and his colleague, Dr. Hiromi Shinya, pioneered the development of a device in 1969 that could remove and cauterize a colorectal polyp during the initial procedure, saving the patient from another exploration of the colon (Martin, 2011).   By experimenting with a more flexible endoscope, aimed at reducing the potential problems of advancing a stiff device through the colon, Dr. Wolff and Dr. Shinya developed an improved device to facilitate visualization of the entire large intestine. Their groundbreaking surgical procedure was published in The New England Journal of Medicine and afterwards, the use of colonoscopy increased throughout the 1970’s, continuing to gain favor as an important tool in the early detection of CRC.


Identification of Pre-cancerous Polyps


The colonoscope was responsible for a significant change in how medical professionals perceive the development of CRC.  Previously, it was believed that colorectal polyps rarely, if ever, developed into cancer; it is now accepted that certain polyps, such as adenomas, can develop into CRC over a period of time (Martin, 2011).  Polyps are seen commonly in the colon (appearing in approximately 30 to 50 percent of adults) while taking years to develop into CRC, making the colonoscopy an ideal tool to use in the screening of pre-cancerous lesions, removing them prior to the development of cancer (Winawer, et al. 2003).


The key to the prevention and early detection of CRC is screening with the detection and removal of pre-cancerous colorectal polyps, before invasive cancer can form.  If CRC is detected early and treated, the five year survival rate is approximately 90%; however because of low screening rates, less than 40% of CRC is found early (CDC, 2011).  A lack of screening leads to later diagnosis of the disease and poorer survival rates.


Current Survival Statistics


During the years 2003 through 2007, the overall age-adjusted CRC death rate decreased from 19.0 per 100,000 in 2003 to 16.7 per 100,000 in 2007, with the incidence of CRC decreased by 3.4% per year (CDC, 2011).  These decreases were part of a larger trend seen in the United States from 1975 to 2007 and are considered an improvement directly related to increased screening and reductions in lifestyle risk factors, as well as improvements in treatment of the disease.  It is not hard to imagine the role Dr. Wolff and his colleague, Dr. Shinya, have had on the impact of this common disease.


If patients aren’t screened, lesions cannot be identified in their earliest stages, and the prognosis of the disease is significantly affected.  Oncology professionals should take note of the contributions of Dr. William Wolff and Dr. Shinya and continue to support and recommend CRC screening.  Providers have been shown to have considerable influence on CRC screening, and while patients can view the colonoscopy as a dreaded procedure, they must be encouraged by health care professionals to undergo screening at appropriate intervals.  Additional screening tools, such as the virtual colonography and advances in stool DNA analysis, may add to the overall screening efforts for the early detection of CRC and pre-cancerous lesions.


References


Centers for Disease Control and Prevention (CDC). Vital signs: Colorectal cancer screening, incidence, and mortality—United States, 2002-2010. MMWR Morbidity and Mortality Weekly Report, 60, 884-889. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6026a4.htm?s_cid=mm6026a4_w


Lieberman, D.A., Weiss, D.G., Bond, J.H., Ahnen, D.J., Garewal, H., & Chejfec, G. (2000). Use of colonoscopy to screen asymptomatic adults for colorectal cancer. New England Journal of Medicine, 343, 162-168. Link to full text http://www.nejm.org/doi/pdf/10.1056/NEJM200007203430301 


Martin, D. (2011). Dr. William Wolff, 94, colonoscopy co-developer, dies. New York Times, Friday, September 2, 2011. Retrieved from http://www.nytimes.com/2011/09/02/nyregion/dr-william-wolff-94-colonoscopy-co-developer-dies.html


Winawer, S., Fletcher, R., Rex, D., Bond, J., Burt, R., Ferruci, J.,… Gatrointestinal Consortium Panel (2003). Colorectal cancer screening and surveillance: clinical guidelines and rational- Update based on new evidence. Gastroenterology, 124, 544-560. Link to abstract http://www.ncbi.nlm.nih.gov/pubmed/12557158


Article Created On : 10/11/2011 11:30:22 AM             Article Updated On : 10/11/2011 11:30:22 AM