Clinical—Alimentary TractUtilization of Surveillance Colonoscopy in Community Practice
Section snippets
Patients and Methods
Sponsored by the National Cancer Institute, the details of the design, conduct, and recruitment for the PLCO trial have been reported.14 In the initial trial design, 60-cm flexible sigmoidoscopy was performed in the intervention group at baseline and again 3 years later. Subjects randomized after 1998 received their second examination 5 years later. Randomization began in November 1993 and was completed in July 2001, with nearly 155,000 people aged 55 to 74 years enrolled. Participants were
Results
Of 3876 subjects selected for inquiry, 3627 (93.6%) responded. Nonresponse was primarily due to death (n = 125; 3.2%) and inability to contact or refusal to participate (n = 124; 3.2%). The characteristics of the included population are presented in Table 1 and are reflective of the overall PLCO population.12 Sixty percent were men, 93.1% were white, and the majority had some college or a college degree (68.6%). Based on the most advanced lesion at diagnostic colonoscopy after screening
Discussion
Our results among hundreds of colonoscopy practitioners in 9 regional US areas show substantial overuse of surveillance colonoscopy among low-risk subjects without adenomatous polyps or symptoms and significant underuse among high-risk subjects with a history of AA. We also found evidence of relatively early use of colonoscopy among subjects with 1 or 2 NAAs, with 33.6% undergoing surveillance colonoscopy within 4 years, when guidelines have advised testing in 5 years2 and more recently in 5–10
Acknowledgments
The authors thank the following coordinators and interviewers, who are so essential to the function of the Prostate, Lung, Colorectal, and Ovarian (PLCO) trial: Georgetown University: Colleen McGuire, Johnsonette Ginyard, Tiffanie Hammond, and Amy Tran; Henry Ford Health System: Karen Broski, Kathy Pratt, Debi Emmer, Sherrie Stanifer, and Joann Kok; Marshfield Clinic: Karen Lappe, Virginia Fischer, Deb Multerer, and Amy Vieth; Pacific Health Research Institute, Hawaii: Victoria Jenkins,
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2023, Clinical Gastroenterology and HepatologyAGA White Paper: Challenges and Gaps in Innovation for the Performance of Colonoscopy for Screening and Surveillance of Colorectal Cancer
2022, Clinical Gastroenterology and HepatologyAutomated identification and assignment of colonoscopy surveillance recommendations for individuals with colorectal polyps
2021, Gastrointestinal Endoscopy
This article has an accompanying continuing medical education activity on page 383. Learning Objective: Upon completion of reading this article, successful learners will be able to understand the currently recommended surveillance intervals for patients with an initial screening colonoscopy, as well as understand factors associated with over and under use of screening and surveillance colonoscopy.
Conflicts of interest The authors disclose no conflicts.
Funding Supported by a contract from the National Cancer Institute (N01-CN2551).