Recent findings suggest that for more effective colorectal cancer prevention, it’s best to choose a physician for colonoscopy with a higher rate of precancerous polyp detection; meaning that he or she detects more polyps than colleagues in proportion to the number of colonoscopies performed. This study appeared in the New England Journal of Medicine.
Colorectal cancer is the second leading cause of cancer death in the United States. For people at average risk of colorectal cancer, the American Cancer Society recommends that routine screening begin at age 50. Recommended options for screening include colonoscopy, sigmoidoscopy, double-contrast barium enema, fecal occult blood tests, fecal immunochemical tests, and stool DNA tests. In addition to detecting cancer at an early stage, colorectal cancer screening can also help to prevent the development of colorectal cancer; some screening tests can identify precancerous polyps that can be removed before they become cancerous.
During a colonoscopy, a flexible tube attached to a camera is inserted through the rectum, allowing physicians to examine the internal lining of the colon and rectum for polyps or other abnormalities. If polyps are identified, they can be removed during the colonoscopy.
It’s widely recommended that for best results, patients have colonoscopies performed by a doctor who has a high rate of detection of precancerous polyps—in most cases a gastroenterologist. It’s not entirely understood, however, the degree to which a doctor’s detection rate affects colorectal cancer prevention and death.
Researchers used patient data from a healthcare delivery organization to assess how a doctor’s polyp detection rate related to colorectal cancer diagnosis. They evaluated over 300,000 colonoscopies performed by 136 gastroenterologists and looked for colorectal cancer diagnosed six months to 10 years after colonoscopy.
Fewer colorectal cancer diagnoses were made among patients whose physicians had higher rates of polyp detection. Specifically, as detection rate among physicians increased by 1%, risk of cancer decreased by 3%. This was true across all stages of colorectal cancer: from early to advanced to death from the disease.
These findings give patients another factor to consider when choosing a physician to perform a colonoscopy. It appears that doctors who find the most precancerous polyps may be the best bet for effective prevention.
Reference: Corley DA, Jensen CD, Mark AR, et al. Adenoma Detection Rate and Risk of Colorectal Cancer and Death. New England Journal of Medicine. 2014 Apr 3;370(14):1298-306. doi: 10.1056/NEJMoa1309086.
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