Surveillance Colonoscopy in Patients at Increased Risk of CRC
Surveillance Colonoscopy in Patients at Increased Risk of CRC
Although colorectal cancer remains the second leading cause of cancer death among men and women in the US, both the incidence and mortality have declined over the past two decades. A substantial proportion of this improvement has been attributed to an increased use of screening. Data from the National Health Interview Survey (NHIS) from 2000 to 2010 suggest that most of the increase in screening has been due to increased use of colonoscopy. An estimated 11–14 million colonoscopies are performed in the US annually.
Approximately 25% of patients who undergo screening colonoscopy have premalignant adenomas that require removal and follow-up (i.e., surveillance) colonoscopy. These patients are considered to be at increased risk of colorectal cancer, and current guidelines recommend that they undergo a repeat exam in 3–5 years. However, there have been surprisingly few studies of surveillance colonoscopy in patients with previous adenomas. Underuse of surveillance colonoscopy remains an ongoing concern in this population.
Appropriate use of surveillance colonoscopy may ultimately improve quality and reduce the cost and burden of colorectal cancer. To address this research need, we examined multilevel factors contributing to underuse of surveillance colonoscopy among patients who are at increased risk for colorectal cancer. Understanding patterns of and factors associated with surveillance colonoscopy use is an important first step toward identifying effective strategies to promote appropriate use of colonoscopy.
Background
Although colorectal cancer remains the second leading cause of cancer death among men and women in the US, both the incidence and mortality have declined over the past two decades. A substantial proportion of this improvement has been attributed to an increased use of screening. Data from the National Health Interview Survey (NHIS) from 2000 to 2010 suggest that most of the increase in screening has been due to increased use of colonoscopy. An estimated 11–14 million colonoscopies are performed in the US annually.
Approximately 25% of patients who undergo screening colonoscopy have premalignant adenomas that require removal and follow-up (i.e., surveillance) colonoscopy. These patients are considered to be at increased risk of colorectal cancer, and current guidelines recommend that they undergo a repeat exam in 3–5 years. However, there have been surprisingly few studies of surveillance colonoscopy in patients with previous adenomas. Underuse of surveillance colonoscopy remains an ongoing concern in this population.
Appropriate use of surveillance colonoscopy may ultimately improve quality and reduce the cost and burden of colorectal cancer. To address this research need, we examined multilevel factors contributing to underuse of surveillance colonoscopy among patients who are at increased risk for colorectal cancer. Understanding patterns of and factors associated with surveillance colonoscopy use is an important first step toward identifying effective strategies to promote appropriate use of colonoscopy.
