Inconsistent Use of Surveillance Colonoscopy
Concerns Authors of Two Studies
Patients with a history of advanced polyps are at
particular risk and should be monitored closely with timely
surveillance, researchers says
Jan. 14, 2010 Surveillance colonoscopy, performed
to monitor patients who have had precancerous polyps (adenomas) found on
a previous colonoscopy, is both overused and underused in with serious
implications for health care and health care spending.
How often patients receive surveillance colonoscopy
may need to be better aligned with their risks for colorectal cancer,
according to two papers published this month by University of Pittsburgh
School of Medicine researchers.
The aim of surveillance is to identify and remove
recurrent growths before they advance to cancer, according to Robert E.
Schoen, M.D., M.P.H., professor of medicine and epidemiology at the
University of Pittsburgh and senior author of both papers.
"Guidelines recommend that patients who have had
pre-cancerous lesions, especially advanced precancerous lesions, get
follow-up colonoscopy earlier and more often than patients who do not
have polyps," said Dr. Schoen.
"Yet our studies show surveillance colonoscopy is
not being used by the medical system in relation to underlying risk."
The first study, published in the January edition
of the journal Gastroenterology, demonstrates a substantial
overuse of surveillance colonoscopy among low-risk patients and
under-use among high risk patients.
The study followed 3,600 patients from the National
Cancer Institute (NCI)-sponsored Prostate, Lung, Colorectal and Ovarian
(PLCO) cancer screening trial. Among 1,026 patients with no precancerous
lesions at their initial examination, 58 percent underwent a follow-up
exam an average of every 3.9 years, although the recommendation would be
to do so every five or 10 years.
Detailed review of the records could not identify
medical reasons for the premature testing. After five years, only 58.4
percent of patients with advanced precancerous lesions received
surveillance colonoscopy despite the recommendation that they do so
every three years.
"High-risk patients aren't receiving timely
follow-up colonoscopy but there is over-utilization among low-risk
patients who are unlikely to develop colon cancer," Dr. Schoen said.
"This misuse wastes health care resources and risks
development of cancers in high-risk patients that might have been
preventable." The second study, published in the January issue of GIE:
Gastrointestinal Endoscopy, emphasizes a persistent, ongoing risk of
cancer, despite colonoscopy, especially among patients with a history of
advanced precancerous lesions.
For the study, 1,297 individuals who participated
in the NCI's Polyp Prevention Trial, a four-year study which examined
the effect of a low-fat, high-fiber, high-fruit and vegetable diet on
precancerous polyp recurrence, were followed for an additional six
years.
What is colonoscopy?
Colonoscopy
is a procedure used to see inside the colon and rectum.
Colonoscopy can detect inflamed tissue, ulcers, and abnormal
growths. The procedure is used to look for early signs of
colorectal cancer and can help doctors diagnose unexplained
changes in bowel habits, abdominal pain, bleeding from the anus,
and weight loss.
More information at National Digestive Diseases Information
Clearing House
Nine cases of colorectal cancer developed although
the individuals had multiple colonoscopies during the 10-year
observation period. Seven out of the nine subjects who developed cancer
had a history of advanced precancerous lesions.
"Despite regular colonoscopy, colorectal cancer may
still occur. This study emphasizes that patients with a history of
advanced polyps are at particular risk and should be monitored closely
with timely surveillance examinations," said Dr. Schoen.
"Combined, these studies seriously indicate how
surveillance colonoscopy is being implemented, and represent a
call-to-action to align colonoscopy use with patient risk, especially in
an era where we are trying to spend our health care dollars as
effectively as possible."
Information source:
University of Pittsburgh School of Medicine
As one of the nation's leading academic centers for
biomedical research, the University of Pittsburgh School of Medicine
integrates advanced technology with basic science across a broad range
of disciplines in a continuous quest to harness the power of new
knowledge and improve the human condition. For more information about
the School of Medicine, see
www.medschool.pitt.edu.
More Links of Archived Reports
Concerning the Colon and Colon Cancer
Jan. 14, 2010 Surveillance colonoscopy, performed
to monitor patients who have had precancerous polyps (adenomas) found on
a previous colonoscopy, is both overused and underused in with serious
implications for health care and health care spending.
Colonoscopy
is a procedure used to see inside the colon and rectum.
Colonoscopy can detect inflamed tissue, ulcers, and abnormal
growths. The procedure is used to look for early signs of
colorectal cancer and can help doctors diagnose unexplained
changes in bowel habits, abdominal pain, bleeding from the anus,
and weight loss.