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Primary care physicians can fill gap in colorectal cancer screening
January 13, 2009AUGUSTA, Ga. - The number of people who need colonoscopies to screen for colorectal cancer is outpacing the number of endoscopists available to perform them, Medical College of Georgia researchers say.
A booming aging population has increased the number of people over 50, the age when the American Cancer Society recommends beginning regular screening for colorectal cancer, the third most common and second most fatal cancer in the United States.
"The key to changing that is catching the disease early through screening," says Dr. Thad Wilkins, a family medicine physician in the MCG School of Medicine. "With slightly more than 12,000 board-certified gastroenterologists, who perform endoscopy procedures like colonoscopies, the capacity for a national screening program is limited. Resources to screen every eligible person for colorectal cancer do not currently exist in the U.S. medical system and, as a result, less than one-third of those who are eligible for colonoscopies are screened."
Properly trained primary care physicians - internists, family medicine physicians, obstetricians and gynecologists and general practitioners - can perform the test as safely and effectively as endoscopists, according to a study published in the January 12 issue of the Annals of Family Medicine.
Dr. Wilkins and colleagues from the University of Virginia Health System and Lexington Medical Center in Lexington, S.C., analyzed 12 studies of 18,292 patients who had colonoscopies performed by a "trained and competent" primary care physician. To determine whether the tests were performed safely and effectively, they looked at the number of complications, such as tears caused by the scope and bleeding problems; the completeness of the test, as measured by whether the physician reached the cecum, or end of the colon; and the polyp and cancer detection rates. Polyps are extra tissue inside the colon that can potentially indicate or turn into cancer.
"In our study we found a very low complication rate - only three cases of perforation and four cases of bleeding complications," he added. The analysis also reflected a nearly 90 percent reach-the-cecum rate, and a polyp-detection rate of nearly 29 percent.
"Each of these outcomes are comparable to published results by other specialists," Dr. Wilkins says. "The take-home point is that colonoscopies performed by trained and competent primary care physicians can be just as safe and effective as those performed by other endoscopists."
The U.S. Preventive Services Task Force and other recognized groups have recommended colonoscopies as a suitable and, perhaps, the most cost-effective screening methods for colorectal cancers.
"Therefore the demand for colonoscopy will continue to grow," Dr. Wilkins says. "Primary care physicians can help meet that demand."
Medical College of Georgia
Properly trained primary care physicians - internists, family medicine physicians, obstetricians and gynecologists and general practitioners - can perform the test as safely and effectively as endoscopists, according to a study published in the January 12 issue of the Annals of Family Medicine.
Dr. Wilkins and colleagues from the University of Virginia Health System and Lexington Medical Center in Lexington, S.C., analyzed 12 studies of 18,292 patients who had colonoscopies performed by a "trained and competent" primary care physician. To determine whether the tests were performed safely and effectively, they looked at the number of complications, such as tears caused by the scope and bleeding problems; the completeness of the test, as measured by whether the physician reached the cecum, or end of the colon; and the polyp and cancer detection rates. Polyps are extra tissue inside the colon that can potentially indicate or turn into cancer.
"In our study we found a very low complication rate - only three cases of perforation and four cases of bleeding complications," he added. The analysis also reflected a nearly 90 percent reach-the-cecum rate, and a polyp-detection rate of nearly 29 percent.
"Each of these outcomes are comparable to published results by other specialists," Dr. Wilkins says. "The take-home point is that colonoscopies performed by trained and competent primary care physicians can be just as safe and effective as those performed by other endoscopists."
The U.S. Preventive Services Task Force and other recognized groups have recommended colonoscopies as a suitable and, perhaps, the most cost-effective screening methods for colorectal cancers.
"Therefore the demand for colonoscopy will continue to grow," Dr. Wilkins says. "Primary care physicians can help meet that demand."
Medical College of Georgia
Colonoscopies Current Events and Colonoscopies News RSSColon cancer screening more effective earlier in day, UCLA study finds
The effectiveness of a screening colonoscopy may depend on the time of day it is performed. According to a new UCLA study, early-morning colonoscopies yielded more polyps per patient than later screenings, and fewer polyps were found hour by hour as the day progressed.
High-definition Colonoscopy Detects More Polyps, Mayo Clinic Researchers Say
High-definition (HD) colonoscopy is much more sensitive than standard colonoscopy in finding polyps that could morph into cancer, say researchers at the Mayo Clinic campus in Florida.
URI research couple's method targets cancerous tumors
Two University of Rhode Island associate professors, biophysicists Yana Reshetnyak and Oleg Andreev, have discovered a technology that can detect cancerous tumors and deliver treatment to them without the harming the healthy cells surrounding them, thereby significantly reducing side effects.
Experts issue call to reconsider screening for breast cancer and prostate cancer
Twenty years of screening for breast and prostate cancer - the most diagnosed cancer for women and men - have not brought the anticipated decline in deaths from these diseases, argue experts from the University of California, San Francisco and the University of Texas Health Science Center at San Antonio in an opinion piece published in the "Journal of the American Medical Association."
How to Lower Costs, Waiting Times for Colonoscopies
Colorectal cancer is a leading cause of cancer-related deaths in the United States, leading to over 50,000 fatalities every year.
Researchers develop new, more-sensitive assay for detecting DNA methylation in colon cancer
A study published in this week's online issue of Nature Biotechnology, demonstrates a unique and highly sensitive method for detecting methylation-associated cancers.
Colon Cancer Screening Technique Shows Continued Promise in New Study
Recent clinical trials show that a new colon cancer screening technique created by Northwestern University researchers has a high enough sensitivity that it could potentially be as or more successful than a colonoscopy in screening for colon cancer.
Improved DNA stool test could detect digestive cancers in multiple organs
Mayo Clinic researchers have demonstrated that a noninvasive screening test can detect not only colorectal cancer but also the common cancers above the colon -- including pancreas, stomach, biliary and esophageal cancers.
Germany: Colonoscopy prevents 15,000 cancer cases
Since 2002, statutory health insurances in Germany have offered an endoscopic examination of the colon (colonoscopy) free of charge for all insured persons from the age of 55. Germany was the first country to make nationwide endoscopic screening for bowel cancer a part of its statutory early cancer detection program.
Water method for unsedated colonoscopy; interval between prep and colonoscopy predicts prep quality
In recognition of National Colorectal Cancer Awareness Month during March, GIE: Gastrointestinal Endoscopy has put out a special issue on colonoscopy for colorectal neoplasia. Studies of note regarding colonoscopy appear in both the monthly March issue and the special issue.
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