Colorectal Screening after Polypectomy: A National Survey Study of Primary Care Physicians

7 November 2006 | Volume 145 Issue 9 | Pages 654-659

Background: Recommendations by primary care physicians for colorectal screening after polypectomy will influence rates of colonoscopy in open-access systems that do not require consultation by a gastroenterologist before colonoscopy.

Objective: To determine the surveillance recommendations of primary care physicians after polypectomy and compare them with recommendations from the U.S. Multisociety Task Force on Colorectal Cancer.

Design: Cross-sectional study of physicians.

Setting: United States.

Participants: A random sample of 500 physicians from the American College of Physicians and 500 physicians from the American Academy of Family Physicians, obtained by using a mail survey.

Measurements: Physicians were asked when they would recommend repeated colonoscopy for a hypothetical 55-year-old man with no family history of colorectal cancer after the following 6 results on colonoscopy: hyperplastic polyp, one 6-mm tubular adenoma, two 6-mm tubular adenomas, one 12-mm tubulovillous adenoma, one 12-mm tubular adenoma with focal high-grade dysplasia, and no polyp but a previous tubular adenoma.

Results: The overall response rate was 57% (568 physicians). Of the respondents, 48% were internists and 52% were family practitioners. Sixty-one percent of respondents would survey a hyperplastic polyp in 5 years or less, 71% would survey a single tubular adenoma in 3 years or less, and 80% would survey 2 tubular adenomas in 3 years or less.

Limitations: The results are based on physicians' self-reported practices from clinical vignettes and may not match actual practice.

Conclusion: Primary care physicians recommend postpolypectomy colonoscopic surveillance more frequently than is recommended by practice guidelines, especially if the colonoscopy showed a hyperplastic polyp or a single small adenoma.

Editors' Notes Context In many health systems, primary care physicians schedule surveillance colonoscopy after polyp removal. Their knowledge of the recommended surveillance intervals will affect the availability of colonoscopy resources. Contribution The authors surveyed a random sample of internists and family physicians by sending them a vignette that depicted a man with polyps on screening colonoscopy. Respondents chose a surveillance colonoscopy interval for each of several screening findings. Most respondents chose shorter surveillance intervals than recommended by professional society guidelines. Cautions A survey tests knowledge, not actual practice. The response rate was 57%. Implications Primary care physicians may order surveillance colonoscopy more frequently than necessary. —The Editors

 

Author and Article Information

From University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio; Henry Ford Hospital, Detroit, Michigan; and Central Texas Veterans Health Care System, Temple, Texas.

Note: This study was orally presented at the American College of Gastroenterology Annual Meeting, 28 October–2 November 2005, Honolulu, Hawaii, and published in abstract form (Am J Gastroenterol. 2005;100:S384-S385). It was selected for the ACG/Olympus Award for the category "Colorectal Cancer Prevention."

Grant Support: Dr. Chak is supported by a K24 Midcareer Award in Patient Oriented Research (DK002800). Dr. Cooper is an Established Investigator in Cancer Prevention, Control and Population Science from the National Cancer Institute (K05 CA90677).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Vikram Boolchand, MD, Division of Gastroenterology, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, PO Box 245028, Tucson, AZ 85724; e-mail, vikramboolchand{at}yahoo.com.

Current Author Addresses: Drs. Boolchand and J. Singh: Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106.

Dr. Olds: Department of Gastroenterology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202.

Dr. P. Singh: Division of Gastroenterology and Hepatology, Department of Medicine, Central Texas Veterans Health Care System, 1901 South 1st Street, Temple, TX 76504.

Drs. Chak and Cooper: Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106.

Author Contributions: Conception and design: V. Boolchand, G. Olds, P. Singh, A. Chak, G.S. Cooper.

Analysis and interpretation of the data: V. Boolchand, A. Chak, G.S. Cooper.

Drafting of the article: V. Boolchand, J. Singh, A. Chak, G.S. Cooper.

Critical revision of the article for important intellectual content: V. Boolchand, G. Olds, P. Singh, A. Chak, G.S. Cooper.

Final approval of the article: V. Boolchand, G. Olds, P. Singh, A. Chak, G.S. Cooper.

Provision of study materials or patients: V. Boolchand, G. Olds, P. Singh.

Statistical expertise: G.S. Cooper.

Obtaining of funding: A. Chak.

Administrative, technical, or logistic support: V. Boolchand, G.S. Cooper.

Collection and assembly of data: V. Boolchand, J. Singh.

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