Elsevier

Gastrointestinal Endoscopy

Volume 60, Issue 6, December 2004, Pages 921-926
Gastrointestinal Endoscopy

Original Article
Prospective evaluation of screening colonoscopy: who is being screened?

https://doi.org/10.1016/S0016-5107(04)02231-XGet rights and content

Background

Universal access to medical procedures is deemed an advantage of the Canadian health care system. The purposes of this prospective study were to determine the degree to which the practice of colon cancer screening by colonoscopy differed among socioeconomic classes and to assess adherence to screening guidelines.

Methods

Consecutive patients scheduled to undergo colonoscopy at a single center between August 2000 and August 2002 completed a questionnaire that determined patient characteristics and indications for the procedure. The patients were divided into two groups: screening patients, defined as individuals who indicated they were undergoing colonoscopy for screening purposes and were asymptomatic, and a control group, which comprised patients undergoing colonoscopy because of symptoms. Statistical analysis was performed to determine if patients in the screening group had different characteristics with respect to socioeconomic class, compared with the control group.

Results

A total of 1088 patients completed the questionnaire: 707 (65%) had colonoscopy because of symptoms, compared with 381 (35%) who underwent a screening examination. Mean age and marital status were similar in both groups. Of all colonoscopy procedures, there was a significantly greater proportion of men undergoing colonoscopy for screening purposes: 199 (52.2%) vs. 294 (41.6%) in the symptomatic group (p = 0.001). Based on the Cochran-Armitage test, patients in the screening group had significantly higher education levels (p = 0.004) and household incomes (p = 0.001).

Conclusions

Income and education level, two indices of socioeconomic status, are statistically significantly higher in patients undergoing screening colonoscopy compared with those having colonoscopy for any other reason.

Section snippets

Study design

The study design was prospective and included patients referred to a gastroenterologist and scheduled for colonoscopy (between August 2000 and August 2002) at a tertiary referral center in a large metropolitan Canadian city. After informed consent was obtained, each patient completed a questionnaire before colonoscopy. Research staff were present to assist with completion of the questionnaire. The ethics committee of our hospital and university approved the protocol for the study.

Data collection

The

Patient demographics

A total of 1088 patients completed the questionnaire (August 2000 to August 2002). Five patients declined to complete the questionnaire. Twenty patients in the screening group indicated they had a history of CRC and were excluded from analysis. There were 707 patients (65%) scheduled for colonoscopy because of symptoms. The three most common symptoms identified by patients were the following: diarrhea (156 patients, 22%), abdominal pain (52 patients, 7.4%), and rectal bleeding (51 patients,

Discussion

Colonoscopy for identification of precancerous lesions accounts for a significant number of the colonoscopies performed in our center. Thirty-five percent of patients who completed the questionnaire specified they had no symptom and were having colonoscopy for screening purposes. This proportion is higher than that of other series from the United States, even after Medicare approved reimbursement for screening colonoscopy in asymptomatic adults over 50 years of age with no risk factor for CRC.

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