| Abstract: |
I was fortunate to have my GI fellowship at the Harvard Medical Division of the Boston City Hospital and the Mallory institute of Pathology, which provided an insight into the evolution of colorectal cancer (CRC) from the adenoma, and the long natural history of cancer development. I observed our cytologist documenting gastric cancer in pernicious anemia (PA) patients from exfoliative cytology years before it became clinically manifest. The long timeline became apparent for many other cancers years later. I also was introduced to gastric cancer screening in Bill Castle’s (Nobel honored for discovery of PA etiology) PA clinic where the fellows urged patients to bring in containers of stool for occult blood testing, in those days using a series of inaccurate reagents. No love was lost when this era passed of refrigerators loaded with those containers of stool waiting to be tested. Finally, I learned about the St. Marks studies that demonstrated residual adenomatous tissue in surgically resected CRC specimens thus making the link between the two. In addition, they showed the progression of CRC from early to advanced stages making the case for early detection and better survival. All of these observations provided the basis for my interest and committment to CRC screening and prevention. © 2025 Elsevier Inc. All rights reserved. |
