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Pitt researchers raise concern over frequency of surveillance colonoscopy
Date:1/14/2010

PITTSBURGH, Jan. 14 How often patients receive surveillance colonoscopy may need to be better aligned with their risks for colorectal cancer, according to two papers published this month by University of Pittsburgh School of Medicine researchers. The studies provide evidence that colonoscopy is both overused and underused in particular patient populations with serious implications for health care spending.

According to Robert E. Schoen, M.D., M.P.H., professor of medicine and epidemiology at the University of Pittsburgh and senior author of both papers, surveillance colonoscopy is performed to monitor patients who have had precancerous polyps, called adenomas, found on a previous colonoscopy. The aim of surveillance is to identify and remove recurrent growths before they advance to cancer.

"Guidelines recommend that patients who have had pre-cancerous lesions, especially advanced precancerous lesions, get follow-up colonoscopy earlier and more often than patients who do not have polyps," said Dr. Schoen. "Yet our studies show surveillance colonoscopy is not being used by the medical system in relation to underlying risk."

The first study, published in the January edition of the journal Gastroenterology, demonstrates a substantial overuse of surveillance colonoscopy among low-risk patients and under-use among high risk patients. The study followed 3,600 patients from the National Cancer Institute (NCI)-sponsored Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial. Among 1,026 patients with no precancerous lesions at their initial examination, 58 percent underwent a follow-up exam an average of every 3.9 years, although the recommendation would be to do so every five or 10 years. Detailed review of the records could not identify medical reasons for the premature testing. After five years, only 58.4 percent of patients with advanced precancerous lesions received surveillance colonoscopy despite the recommendati
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Contact: Courtney McCrimmon
McCrimmonCP@upmc.edu
412-586-9773
University of Pittsburgh Schools of the Health Sciences
Source:Eurekalert

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