Screening colonoscopy in asymptomatic average-risk African Americans

Rex, Douglas K.; Khan, Abdul Moiz; Shah, Prince; Newton, Jeanette; Cummings, Oscar W.

doi:10.1016/s0016-5107(00)70283-5

Cited by 49 publications

(36 citation statements)

References 18 publications

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“…5 Guidelines recommend colonoscopy as a suitable screening method, 1,4,6,7 and evidence is increasing that colonoscopy may be the most cost-effective approach. 3,[8][9][10][11][12][13][14] As a result, the demand for screening colonoscopy is rapidly growing. The resources needed to screen every eligible person using colonoscopy do not currently exist in the US medical system, however, 15 and fewer than one-third of those who are eligible for colonoscopy are screened.…”

Section: Introductionmentioning

confidence: 99%

Screening Colonoscopies by Primary Care Physicians: A Meta-Analysis

Wilkins¹,

LeClair

Smolkin³

et al. 2009

The Annals of Family Medicine

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PURPOSE There is currently too few endoscopists to enact a national colorectal cancer screening program with colonoscopy. Primary care physicians could play an important role in fi lling this shortage by offering screening colonoscopy in their practice. The purpose of this study was to examine the safety and effectiveness of colonoscopies performed by primary care physicians. METHODSWe identifi ed relevant articles through searches of MEDLINE and EMBASE bibliographic databases to December 2007 and through manual searches of bibliographies of each citation. We found 590 articles, 12 of which met inclusion criteria. Two authors independently abstracted data on study and patient characteristics. Descriptive statistics were performed. For each outcome measure, a random effects model was used to determine estimated means and confi dence intervals. RESULTSWe analyzed 12 studies of colonoscopies performed by primary care physicians, which included 18,292 patients (mean age 59 years, 50.5% women). The mean estimated adenoma and adenocarcinoma detection rates were 28.9% (95% confi dence interval [CI], 20.4%-39.3%) and 1.7% (95% CI, 0.9%-3.0%), respectively. The mean estimated reach-the-cecum rate was 89.2% (95% CI, 80.1%-94.4%). The major complication rate was 0.04% (95% CI, 0.01%-0.07%); no deaths were reported.CONCLUSIONS Colonoscopies performed by primary care physicians have quality, safety, and effi cacy indicators that are comparable to those recommended by the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, and the Society of American Gastrointestinal Endoscopic Surgeons. Based on these results, colonoscopy screening by primary care physicians appears to be safe and effective. Ann Fam Med 2009;7:56-62. DOI: 10.1370/afm.939. INTRODUCTION C olorectal cancer1-4 is the third most common cancer and second leading cause of cancer mortality in the United States.5 Guidelines recommend colonoscopy as a suitable screening method, 1,4,6,7 and evidence is increasing that colonoscopy may be the most cost-effective approach. 3,[8][9][10][11][12][13][14] As a result, the demand for screening colonoscopy is rapidly growing. The resources needed to screen every eligible person using colonoscopy do not currently exist in the US medical system, however, 15 and fewer than one-third of those who are eligible for colonoscopy are screened. 3,16 There has been a recent call for monitoring quality indicators in endoscopy to support continuous quality improvement among endoscopists. Proposed measures for quality include reach-the-cecum rates, adenoma detection rates, advanced adenoma detection rates, and withdrawal times. 14,17,18 In the United States, a comprehensive task force of the American Society of Gastrointestinal Endoscopists and the American College of Gastroenterology has recommended acceptable standards for these qual- 19 In the United Kingdom, the Joint Advisory Group on GI Endoscopy (JAG) established standards for colonoscopies regardless of specialty. These standards state t...

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Section: Introductionmentioning

confidence: 99%

Screening Colonoscopies by Primary Care Physicians: A Meta-Analysis

Wilkins¹,

LeClair

Smolkin³

et al. 2009

The Annals of Family Medicine

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“…SUNG et al (49) studied a Chinese asymptomatic population and described a prevalence of 20.2% (102/505) for adenomas and 3.8% (19/505) for adenomas larger than 10 mm. REX et al (44) found a prevalence rate of 34.7% (42/121) for adenomas and 2.5% (3/121) for advanced adenomas in a study of asymptomatic African Americans. ANDERSON et al (2) found a prevalence rate of 10.2% for important neoplasias (adenocarcinomas, advanced adenomas or more than two adenomas) in an asymptomatic population screened for colon cancer.…”

Section: Discussionmentioning

confidence: 96%

“…Polyp size is not the sole criterion to defi ne an advanced polyp, but it has been used in most studies (5,9,17,19,20,25,28,39,44) . Moreover, it is the only criterion objectively available for the endoscopist at the time of sigmoidoscopy or colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, in countries with limited resources, patients may wait a long time to have their colon completely examined. As there has been discussion about the use of sigmoidoscopy as a screening population tool (by selecting those who should undergo colonoscopy) (47) based on the fact that asymptomatic patients 50 years or older with adenomatous lesions in the distal colon are at a greater risk of having proximal neoplasias (5,9,14,17,19,20,25,28,39,44) , it would be important to understand what would happen if the same rationale was applied to a group of patients routinely seen in an outpatient gastrointestinal endoscopy unit. In other words, verify if there is a role for using sigmoidoscopy -an easier, safer and less expensive procedure than colonoscopy (33) -as a first exam in this population.…”

Section: Introductionmentioning

confidence: 99%

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Is there a role for sigmoidoscopy in symptomatic patients? Analysis of a study correlating distal and proximal colonic neoplasias detected by colonoscopy in a symptomatic population

Binda

Pereira-Lima

Nunes

et al. 2007

Arq. Gastroenterol.

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-Background -Colonoscopy is the gold standard exam to investigate patients with colonic complaints. However, its availability is limited in developing countries. Sigmoidoscopy has been advocated as a first procedure in colorectal cancer screening strategies, in order to select those who need colonoscopy. Aim -To study the correlation between distal and proximal colonic neoplasias in symptomatic patients 50 years or older and patients 40 to 49 years old who underwent colonoscopy at a gastrointestinal endoscopy unit in 1999 and 2000 with the purpose to evaluate its role in a symptomatic population. Methods -All colonoscopies performed in our Department in 1999-2000 were reviewed. The distal colon was defined as the colonic segment aboral to the splenic flexure. Advanced neoplasias were defined as adenomas larger than 10 millimeters and adenocarcinomas. Results -Of the 2,701 colonoscopies retrieved, 1,125 were enrolled in this study. Prevalence rates for adenoma, advanced adenoma and carcinoma were 28.9%, 4.6% and 4% in the group of 830 patients 50 years or older (mean age 65 years, 491 women). The finding of one small (<10 mm) adenoma in the distal bowel doubled the likelihood of finding a proximal neoplasia (OR = 2.12, 95% CI, 1.27-3.54), and multiple (OR = 3.99, 95% CI, 1.72-9.28) or advanced (OR = 3.73, 95% CI, 1.81-7.7) adenomas increased this risk even further. Of the patients without adenoma or carcinoma in the distal colon, 1.93% had proximal advanced neoplasia. In the group of 40 to 49-year-old patients (n = 395; mean age 44.8 years, 208 women) the prevalence of adenomas (14.9%), advanced adenomas (3.4%), and carcinomas (1.7%) was lower. Conclusions -The likelihood of finding a proximal lesion is greater in patients with distal neoplasias. This likelihood is further increased when adenomas are multiple or larger than 10 mm. One out of 52 patients 50 years or older with an apparently normal distal colon has advanced proximal neoplasia. Sigmoidoscopy is not an adequate exam for symptomatic patients aged 50 years or older. HEADINGS -Colonoscopy. Sigmoidoscopy. Proctoscopy. Colonic polyps. Colorectal neoplasms. Adenoma.

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“…The cost-effectiveness of screening, adjusted for age-specific incidence rates, proportion of localized, left-sided cancers and life expectancy estimates is the highest in African-Americans, then Caucasians, then Asians and the lowest in Latinos [13]. Although the overall prevalence of adenomas in African-Americans seems comparable to that of the white population [14], available data may suggest a need for earlier initiation of CRC screening in African-Americans than in other populations [12]. …”

Section: Patient-tailored Colonoscopic Screeningmentioning

confidence: 99%

Colorectal Cancer Screening by Colonoscopy – Current Issues

Reguła¹

2007

Digestion

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Of all colorectal cancer screening methods, colonoscopy used as a primary screening tool is both the most promising and the most discussed in the current literature. Several countries have introduced colonoscopic screening on a national scale, but many issues still require further research. The practicality of using colonoscopic screening can be questionable given the huge target population, which requires a great increase in endoscopic resources. Limiting the target population by shifting the use of colonoscopy from low-risk to high-risk groups is a valid option. The quality of colonoscopy related to the individual colonoscopist’s skill has become a surprisingly considerable problem, and it is obvious that continuous quality improvement programs need to be established. The accuracy of detecting important colorectal lesions is also still influenced by the old problem of cleansing the large bowel, and further research would be welcome. Technological improvements in current endoscopic equipment will hopefully increase the diagnostic yield of colonoscopy and eventually strengthen its use in the setting of colorectal cancer screening.

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Screening colonoscopy in asymptomatic average-risk African Americans

Cited by 49 publications

References 18 publications

Screening Colonoscopies by Primary Care Physicians: A Meta-Analysis

Screening Colonoscopies by Primary Care Physicians: A Meta-Analysis

Is there a role for sigmoidoscopy in symptomatic patients? Analysis of a study correlating distal and proximal colonic neoplasias detected by colonoscopy in a symptomatic population

Colorectal Cancer Screening by Colonoscopy – Current Issues

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