The Doctor Who Does Your Colonoscopy Matters

Those with higher polyp detection rates prevent more cancers, save more lives, study says

Tuesday, June 16, 2015

TUESDAY, June 16, 2015 (HealthDay News) -- The doctor performing your colonoscopy makes a difference in whether you'll develop colon cancer or die from it, a new study finds.

Colonoscopy saves lives, and "high quality" colonoscopies save even more, the study authors said. High quality means screening by doctors adept at identifying many precancerous growths (polyps), they said.

"The results further suggest that efforts to improve the detection and removal of precancerous polyps will likely not only help patients, but will support current efforts to improve the quality of the test and be cost-effective," said study lead author Reinier Meester, of Erasmus MC University Medical Center in Rotterdam, the Netherlands.

In the study, higher-quality colonoscopies were associated with a 50 to 60 percent lower risk for colon cancer and colon cancer fatalities over a patient's lifetime.

Higher-quality screenings did not translate into more expensive screenings, the research team noted in the June 16 issue of the Journal of the American Medical Association.

The purpose of screening colonoscopy is to detect and remove early cancerous or precancerous lesions. During the outpatient procedure, a doctor uses a scope to examine the inside of the large intestine.

The American Cancer Society recommends that most people undergo colon cancer screening beginning at the age of 50. This means either a colonoscopy every 10 years or one of several other options every five years: flexible sigmoidoscopy, virtual colonoscopy, or double-contrast barium enema.

To assess how the detection rate of a colonoscopy may affect a patient's future cancer risk, the study team looked at data concerning nearly 57,600 patients who were part of the Kaiser Permanente Northern California health care system.

Those patients who underwent colon cancer screening had their colonoscopies performed by 136 different doctors between 1998 and 2010.

The analysis concluded that undergoing a colonoscopy, regardless of quality, does save lives. For example, the lifetime colon cancer risk among those who didn't get screened was more than 34 per 1,000. This compared with less than 27 per 1,000 among those screened by doctors who were the least adept at spotting polyps and under 13 per 1,000 for those screened by the most skillful polyp spotters.

For this study, physicians were rated based on the number of adenomas (polyps likely to be cancerous) detected and the number of colonoscopies he or she performed.

Dr. Andrew Chan, an associate professor of medicine at Harvard Medical School, said the finding "adds to the growing body of evidence that variation in the quality of colonoscopies is associated with substantial differences in the ability of the test to prevent colorectal cancer."

The most important finding from this study, Chan said, is that a higher rate of detection of precancerous polyps does not lead to greater overall costs to the health care system.

"From a public health standpoint, this suggests that our current strategy of striving to find as many polyps as possible does not lead to tradeoffs in terms of higher costs," Chan said.

But how do patients find the best colonoscopy doctor for the job? Meester himself acknowledges that in many settings there are no reliable data to measure detection of adenomas.

Dr. David Carr-Locke, chief of the digestive diseases division at Beth Israel Medical Center in New York City, suggested the first thing is to ensure that the physician has the appropriate training in colonoscopy and, if possible, can quote his or her adenoma detection rate for a screening colonoscopy.

"Membership in the American Society for Gastrointestinal Endoscopy or other local professional societies that require documentation of training is a good guide," he said. "Health care systems sometimes issue colonoscopy quality report cards per physician. The Centers for Medicare and Medicaid Services will also be scrutinizing physicians' performance quality in the near future and are likely to make these data public knowledge."

After your colonoscopy, Carr-Locke said, "your physician should inform you of the pathology of the polyps removed and tell you when your next colonoscopy should be performed according to published national guidelines."

SOURCES: Reinier G.S. Meester, M.Sc., department of public health, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Andrew Chan, M.D., M.P.H., associate professor, department of medicine, Harvard Medical School, and associate professor, medicine, gastroenterology, Massachusetts General Hospital, Boston; David Carr-Locke, M.D., chief, division of digestive diseases, associate chair, medicine for academic affairs, Beth Israel Medical Center, New York City; June 16, 2015, Journal of the American Medical Association

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