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Family Docs Do Colonoscopies Safely

Study found no more complications than when specialists perform screening test

THURSDAY, Jan. 15 (HealthDay News) -- Colonoscopies performed by family doctors who are trained to conduct the procedure are safe, effective and meet standard quality guidelines for colon cancer screenings, new research reveals.

The finding is based on an analysis of 12 earlier studies conducted between 1966 and 2007, all of which focused specifically on the outcomes of colonoscopies performed by primary-care physicians -- as opposed to gastrointestinal specialists.

Noting that the nation's approximately 12,000 board-certified gastroenterologists are not sufficient in number to meet the ideal screening needs of the country's third most common cancer, the authors said that the findings should encourage a "fundamental role" for properly trained primary-care physicians -- particularly in rural areas -- as part of an effort to broaden access to colonoscopies.

"But I want to emphasize that this doesn't apply to all primary-care physicians in general," cautioned study author Dr. Thad Wilkins, from the department of family medicine at the Medical College of Georgia, in Augusta. "Our study is only evaluating the outcomes of colonoscopies performed by those doctors who are trained and competent in performing a colonoscopy, and that amounts to about 5 percent of all primary-care physicians. But among those that are trained, the results are comparable to those of specialists."

Wilkins and his colleagues reported their observations in the January/February edition of the Annals of Family Medicine.

Dr. Durado Brooks, director of colorectal cancer for the American Cancer Society, expressed little surprise with the findings, but advised patients to screen their physicians carefully.

"Most people who finish medical school would be widely capable of doing any number of procedures in a high-quality fashion if they have the appropriate training," he said. "So that's the key. Training."

"That means that on a basic level, you want to know if there is a quality monitoring system in place at the facility in which the primary-care physician practices," Brooks suggested. "And what sort of formal training your doctor had, and how many of these procedures have he or she performed in their past, and how often have they performed them recently. These are the important questions."

In the study, the researchers pointed out that colorectal cancer is currently the second leading cause of cancer death in the United States. They further noted that, despite the fact that less than a third of eligible patients now avail themselves of colonoscopies, the demand for such screenings is nonetheless growing fast.

To control for screening quality, the American Society of Gastrointestinal Endoscopists and the American College of Gastroenterology have recommended standards for methodology and detection sensitivity.

The 12 studies Wilkins and his team reviewed included slightly more than 12,000 colonoscopy patients, evenly split between men and women, with an average patient age of 59. Most of the screenings in the studies were performed by family physicians.

No one in the pool of patients died as a result of a colonoscopy, the authors observed, and just seven patients experienced either bleeding or colonic perforation complications. This complication frequency falls within standard guidelines, the researchers noted.

In just over 89 percent of screenings, the physicians were able to successfully conduct a proper and full rectum to cecum examination, in which the screening physician uses the telescopic device (colonoscope) to examine the entire colon.

Screening recommendations suggest that 90 percent to 95 percent of colonoscopies should meet this objective.

In that regard, the researcher noted that most colonoscopies now involve conscious sedation, and that when reviewing only those types of screenings, the rate actually went up to 90.5 percent.

And with respect to adequate spotting of benign or precancerous tumor growths known as adenomas, Wilkins and his colleagues found that the detection rate was nearly 30 percent -- again, well within recommended standards.

The researchers therefore concluded that colonoscopies performed by primary-care physicians are indeed safe and effective, so long as the physician is trained to conduct such screenings.

"Patients should simply ask their general practitioner if they are trained in colonoscopies," Wilkins advised. "And ask them, if so, how many they perform annually, the way you should and would when considering a doctor for any type of surgery or procedure."

On another note, other studies published in the same journal highlighted positive and negative findings, respectively, with regards to a different form of colon cancer screening known as the home fecal occult blood test (FOBT).

Long recommended as an effective annual method for initial colorectal cancer screening, one study led by Dr. Michael B. Potter, from the department of family and community medicine at the University of California, San Francisco, found that FOBT screening rates go up dramatically -- by almost 30 percent -- if the option is offered to patients while attending an annual flu shot clinic.

On the other hand, a second study led by Dr Masahito Jimbo, of the department of family medicine at the University of Michigan, suggested that a significant number of primary-care physicians fail to encourage their patients to adhere to guidelines that advise those who receive a positive FOBT result to undergo more rigorous follow-up screenings, such as a colonoscopy. Jimbo and his team called for colorectal screening programs to include specific physician guidance instruction as to when to prescribe additional evaluations.

More information

For more on colon cancer screening guidelines, visit the American Cancer Society.

SOURCES: Thad Wilkins, M.D., department of family medicine, Medical College of Georgia, Augusta; Durado Brooks, M.D., director, colorectal cancer for the American Cancer Society, Atlanta; January/February 2009, Annals of Family Medicine

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