Colorectal Screening after Polypectomy

5 June 2007 | Volume 146 Issue 11 | Pages 820-821

IN RESPONSE:

We are pleased to see the interest of Dr. Antaki and Dr. Otto in our survey study of primary care physicians regarding postpolypectomy surveillance. As we report in our article, constantly changing guidelines from various societies remain an issue for the primary care physician. In 2003, the USMSTF guidelines (1) for colorectal cancer screening and surveillance were developed by a panel of both gastroenterology and primary care societies and the ACS guidelines (2) were from a single society and included recommendations for the early detection of several types of cancer. As Dr. Antaki pointed out, there was an inconsistency between the ACS and USMSTF guidelines regarding surveillance for adenomas smaller than 1 cm (3 to 6 years vs. 5 years, respectively). Although we did not ask our respondents the reasoning for their recommendations, it is unlikely the primary care practitioner weighed these 2 different sets of guidelines when deciding surveillance intervals. If respondents based their answer on the ACS guidelines, an equal number of the respondents would have chosen 3 years and 5 years for follow-up of a small tubular adenoma. In our survey, almost the same number (25%) of respondents chose to survey a small tubular adenoma in 1 year or less as those who chose 5 years, and 46% chose a 3-year surveillance interval.

This suggests that when given a range of guideline-based intervals, most respondents would tend to recommend surveillance at or before the earliest interval. We agree that the combined ACS and USMSTF guidelines from 2006 (3) will hopefully decrease confusion over surveillance guidelines from several societies.

We appreciate the comments from Dr. Otto regarding the need for communication between endoscopists and primary care physicians. One conclusion from our study is that further educational efforts are necessary to change current inappropriate referral patterns. An important part of this change may include recommendations to the primary care physician for the next surveillance colonoscopy based on the index colonoscopy findings after the pathology of polyps has been read. The excessive use of more frequent colonoscopy than is necessary may need to be emphasized to overcome current fears of small missed polyps and the development of colorectal neoplasia in very-low-risk patients.

Author and Article Information

Top Author & Article Info References

From the University of Arizona, Tucson, AZ 85724, and Case Medical Center, Cleveland, OH 44106.

Potential Financial Conflicts of Interest: None disclosed.

References

Top Author & Article Info References

1. Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale. Update based on new evidence. Gastroenterology. 2003;124:544-60. [PMID: 12557158].[Medline]

2. Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2003. CA Cancer J Clin. 2003;53:27-43. [PMID: 12568442].[Abstract/Free Full Text]

3. Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O'Brien MJ, Levin B, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872-85. [PMID: 16697750].[Medline]