Colorectal Screening after Polypectomy: A National Survey Study of Primary Care Physicians
- Vikram Boolchand, MD;
- Gregory Olds, MD;
- Joseph Singh, MD;
- Pankaj Singh, MD;
- Amitabh Chak, MD; and
- Gregory S. Cooper, MD
- 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.
Abstract
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.
Article and Author Information
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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.”
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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).
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Potential Financial Conflicts of Interest: None disclosed.
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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.
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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.
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Dr. Olds: Department of Gastroenterology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202.
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Dr. P. Singh: Division of Gastroenterology and Hepatology, Department of Medicine, Central Texas Veterans Health Care System, 1901 South 1st Street, Temple, TX 76504.
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Drs. Chak and Cooper: Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106.
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Author Contributions: Conception and design: V. Boolchand, G. Olds, P. Singh, A. Chak, G.S. Cooper.
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Analysis and interpretation of the data: V. Boolchand, A. Chak, G.S. Cooper.
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Drafting of the article: V. Boolchand, J. Singh, A. Chak, G.S. Cooper.
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Critical revision of the article for important intellectual content: V. Boolchand, G. Olds, P. Singh, A. Chak, G.S. Cooper.
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Final approval of the article: V. Boolchand, G. Olds, P. Singh, A. Chak, G.S. Cooper.
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Provision of study materials or patients: V. Boolchand, G. Olds, P. Singh.
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Statistical expertise: G.S. Cooper.
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Obtaining of funding: A. Chak.
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Administrative, technical, or logistic support: V. Boolchand, G.S. Cooper.
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Collection and assembly of data: V. Boolchand, J. Singh.
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