Tuesday, May 17, 2011

Excessive use of screening colonoscopy

According to guidelines from multiple expert groups, including those of the American College of Gastroenterology and the U.S. Preventive Services Task Force, the appropriate interval between colonoscopies for colorectal cancer screening is 10 years. But a study published last week in the Archives of Internal Medicine found that nearly 1 in 4 Medicare patients who had a normal screening colonoscopy examination from 2001 to 2003 underwent another colonoscopy within 7 years with no other medical indications. This study confirmed previous reports of endoscopists advising patients to return for repeat colonoscopies at substantially shorter intervals than those recommended in current guidelines.

Overuse of screening colonoscopy provides no additional health benefits to patients, but increases the risk of adverse effects, causes unnecessary medical expenses, and diverts resources that might otherwise be available to assist the nearly 40 percent of eligible Americans who are not up-to-date on colorectal cancer screening. Although more adults are being screened today than ever before, much work remains to be done, as family physician Doug Campos-Outcalt wrote in a previous editorial:

Although [colorectal cancer screening] trends show improvement, significant disparities persist. Racial or ethnic minorities and those with no health insurance, low incomes, or less than a high school education have significantly lower rates of use of colorectal cancer testing. There are several hypothesized reasons to explain low adherence to recommendations. These include lack of a medical home, lack of health insurance, lack of awareness of the need, and failure of physicians to recommend screening. Family physicians can address the last two issues; policy makers need to address the first two.

Fecal occult blood testing and flexible sigmoidoscopy are also recommended options for reducing colorectal cancer mortality in adults 50 to 75 years of age. However, evidence suggests that colonoscopy has become the colorectal screening cancer test of choice for many family physicians. What has been your experience with referring patients for screening colonoscopy? Have you observed excessive colonoscopy use for patients without indications other than screening?

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The above post was originally published on the AFP Community Blog.

1 comment:

  1. In my area, the GIs would recommend rescreening in 5 years after a completely normal colonoscopy in a patient without risk factors for colon cancer. Sometimes they would also recommend annual stool cards as well! It was driving me nuts. I would counsel the patients on the recommendations and go over the pros and cons, and almost every time they would go for 10 years and skip the annual stool cards. While I documented it as best I could, it still felt like the GIs were playing some serious CYA medicine and we were getting risk dumped in our laps when we tried to do right by the patient.

    Fortunately, over the last few years things have improved in my area: the GIs are now more often recommending q10y colonoscopies and dropping the stool card nonsense.

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