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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
Colonoscopy is expensive, is time-consuming for patients, and can have complications. Therefore, it is important to adjust the frequency of colonoscopy to the likelihood that new polyps or cancer will occur. The United States Multisociety Task Force (USMSTF) on Colorectal Cancer is a group of representatives from several professional organizations that has developed guidelines about how often to repeat colonoscopy for patients with different types of polyps. A recent survey of gastroenterologists and surgeons suggested that they believed in more frequent colonoscopy than the guidelines recommended.
SUMMARIES FOR PATIENTS
Colorectal Cancer Screening in Patients after Polyp Removal: A Survey of Primary Care Physicians
7 November 2006 | Volume 145 Issue 9 | Page I-26
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "Colorectal Screening after Polypectomy: A National Survey Study of Primary Care Physicians." It is in the 7 November 2006 issue of Annals of Internal Medicine (volume 145, pages 654-659). The authors are V. Boolchand, G. Olds, J. Singh, P. Singh, A. Chak, and G.S. Cooper.
What is the problem and what is known about it so far?
Colorectal cancer (cancer of the colon [large intestine] or rectum) is a common cause of cancer death in the United States. Experts recommend that people 50 years of age and older get colon cancer screening. Most cancer of the colon begins as polyps, which are benign (noncancerous) growths on the colon's inner surface. Removing a polyp prevents it from ever becoming cancer. There are different kinds of polyps, some that are likely to become cancer and some that rarely do. Doctors can remove polyps during colonoscopy. Colonoscopy is a procedure during which doctors examine the inside of the colon with a flexible, lighted instrument. After removing a polyp, doctors often repeat the colonoscopy periodically to look for new polyps or cancer.
Why did the researchers do this particular study?
To compare primary care doctors' recommendations with USMSTF guidelines on the frequency of surveillance colonoscopy.
Who was studied?
568 primary care physicians who were members of the American College of Physicians or the American Academy of Family Physicians.
How was the study done?
The researchers mailed a survey to 500 members of the American College of Physicians and 500 members of the American Academy of Family Physicians. The surveys asked the doctors when they would recommend repeated colonoscopy after 6 different possible colonoscopy results that ranged from no polyp to a large polyp with precancerous changes.
What did the researchers find?
Of the 1000 doctors contacted, only 568 completed the survey. In general, responding doctors reported that they would recommend repeated colonoscopy sooner than the guidelines recommended. This was especially true for the types of polyps that are least likely to become cancer.
What were the limitations of the study?
The guidelines that were available at the time of the survey did not offer specific recommendations for 2 of the 6 types of polyps included in the survey. Many of the surveyed doctors did not respond, and the results show what the doctors said they would do rather than what they actually did.
What are the implications of the study?
Primary care doctors may be recommending more frequent repeated colonoscopy for patients who have had a polyp removed than guidelines recommend. Organizations that develop these guidelines need to better educate doctors about them.
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  B. Levin, D. A. Lieberman, B. McFarland, R. A. Smith, D. Brooks, K. S. Andrews, C. Dash, F. M. Giardiello, S. Glick, T. R. Levin, et al. Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology CA Cancer J Clin, May 1, 2008; 58(3): 130 - 160. [Abstract] [Full Text] [PDF]
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 A. O. Laiyemo, G. Murphy, P. S. Albert, L. B. Sansbury, Z. Wang, A. J. Cross, P. M. Marcus, B. Caan, J. R. Marshall, P. Lance, et al. Postpolypectomy Colonoscopy Surveillance Guidelines: Predictive Accuracy for Advanced Adenoma at 4 Years Ann Intern Med, March 18, 2008; 148(6): 419 - 426. [Abstract] [Full Text] [PDF]
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T. F. Imperiale and H. C. Sox Guidelines for Surveillance Intervals after Polypectomy: Coping with the Evidence Ann Intern Med, March 18, 2008; 148(6): 477 - 479. [Full Text] [PDF]
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F. Antaki Colorectal Screening after Polypectomy Ann Intern Med, June 5, 2007; 146(11): 820 - 820. [Full Text] [PDF]
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H. F. Otto Colorectal Screening after Polypectomy Ann Intern Med, June 5, 2007; 146(11): 820 - 820. [Full Text] [PDF]
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 Primary Care Physicians Overuse Colonoscopy Journal Watch Gastroenterology, February 2, 2007; 2007(202): 2 - 2. [Full Text]
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