Medicine
**
The above post was originally published on the AFP Community Blog.
- Breast Cancer And The Angelina Jolie Effect
There is nothing like a celebrity to call attention to a preventable disease, especially if that disease is cancer. In March 2000, then-Today Show host Katie Couric, whose husband Jay Monahan died of colorectal cancer in 1998, underwent a live colonoscopy...
- Why Screening For Colorectal Cancer Shouldn't Be A Hard Sell
Breast and prostate cancer screening tests may dominate headlines, but in terms of the quality of the scientific evidence that early detection saves lives, there are no better cancer screening tests than those for colorectal cancer, or cancer of the large...
- Challenging Conventional Clinical Wisdom
Over the past few years, I've been invited to speak twice at Lancaster General Hospital (PA) about studies of the effects of screening for colorectal and prostate cancer. Recognizing the need to further explore the controversies surrounding the evidence...
- The Presidential Physical
Based on standards set by the U.S. Preventive Services Task Force (USPSTF), the widely respected independent committee of primary care health professionals that for more than 25 years has rigorously reviewed the evidence for benefits of clinical preventive...
- Information On Colorectal Cancer Screening
If you’re a man or woman over 50, chances are that you’ve been told about the importance of being checked for cancer of the prostate or breast. Finding some types of cancers at early stages (before they cause symptoms) may increase one’s chances...
Medicine
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?
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?
The above post was originally published on the AFP Community Blog.
- Breast Cancer And The Angelina Jolie Effect
There is nothing like a celebrity to call attention to a preventable disease, especially if that disease is cancer. In March 2000, then-Today Show host Katie Couric, whose husband Jay Monahan died of colorectal cancer in 1998, underwent a live colonoscopy...
- Why Screening For Colorectal Cancer Shouldn't Be A Hard Sell
Breast and prostate cancer screening tests may dominate headlines, but in terms of the quality of the scientific evidence that early detection saves lives, there are no better cancer screening tests than those for colorectal cancer, or cancer of the large...
- Challenging Conventional Clinical Wisdom
Over the past few years, I've been invited to speak twice at Lancaster General Hospital (PA) about studies of the effects of screening for colorectal and prostate cancer. Recognizing the need to further explore the controversies surrounding the evidence...
- The Presidential Physical
Based on standards set by the U.S. Preventive Services Task Force (USPSTF), the widely respected independent committee of primary care health professionals that for more than 25 years has rigorously reviewed the evidence for benefits of clinical preventive...
- Information On Colorectal Cancer Screening
If you’re a man or woman over 50, chances are that you’ve been told about the importance of being checked for cancer of the prostate or breast. Finding some types of cancers at early stages (before they cause symptoms) may increase one’s chances...