National Survey of Doctors' Beliefs about How Frequently Colonoscopy Should Be Done after Removal of a Colon Polyp. Ann Intern Med. 2004;141:I-22. doi: 10.7326/0003-4819-141-4-200408170-00002
Download citation file:
Published: Ann Intern Med. 2004;141(4):I-22.
Most cancers of the colon begin as noncancerous (benign) polyps, which are growths on the inner surface of the tubelike large intestine. There are several different kinds of polyps, some of which may become cancerous growths and some of which rarely do. Doctors use a procedure known as colonoscopy (examination of the inside of the colon with a lighted tube) to check for polyps because removing a benign polyp prevents it from ever changing into a cancerous growth. After removing a benign polyp, doctors often repeat the colonoscopy periodically (surveillance colonoscopy) to ensure that no additional polyps have appeared. Several professional societies have written guidelines that advise doctors how often to repeat colonoscopy, depending on the chances that a particular kind of polyp is likely to recur and become cancerous. Because colonoscopy is expensive and requires a lot of physician time, it is important to tailor the frequency of surveillance colonoscopy to the likelihood that colon polyps will recur.
To determine whether gastroenterologists and general surgeons were following professional society guidelines on the frequency of surveillance colonoscopy.
349 gastroenterologists and 317 general surgeons from all parts of the United States.
Each study participant received a questionnaire in the mail that consisted of 40 questions about the doctor's beliefs, opinions, and practices concerning colon cancer screening. The questionnaire also presented 4 hypothetical patients with different kinds of colon polyps and asked doctors how often surveillance colonoscopy should be performed.
Even when the initial colon polyp was a type for which professional society guidelines did not recommend surveillance colonoscopy, 25% of gastroenterologists and 56% of general surgeons would have performed the procedure and most would have done so every 5 years or more often. When a single polyp with relatively small risk for recurrence had been removed (professional societies recommend surveillance colonoscopy every 3 to 5 years in this instance), more than half of gastroenterologists and general surgeons would have performed the procedure within 3 years or sooner; one third of the general surgeons would never discontinue surveillance. In the case of large or multiple initial polyps (most professional societies recommend surveillance colonoscopy every 3 to 5 years), almost one half of gastroenterologists and 80% of general surgeons recommended having the procedure more often than once every 3 years.
The results of the survey were based on what the doctors said they would do rather than what they may actually have done in practice.
It seems that doctors are greatly overusing surveillance colonoscopy, a finding that, if true, has serious adverse financial and manpower implications for the health system of the United States.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Results provided by:
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only