Original ArticleProspective evaluation of screening colonoscopy: who is being screened?
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.
References (30)
- et al.
Prospective determination of distal colon findings in average-risk patients with proximal colon cancer
Gastrointest Endosc
(1999) Colonoscopy for colorectal cancer: too much, too little, just right. ASGE Distinguished Lecture 1993
Gastrointest Endosc
(1993)Endoscopic screening for colorectal cancer
Gastroenterol Clin North Am
(1997)- et al.
Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology
Am J Gastroenterol
(2000) - et al.
Volume and yield of screening colonoscopy at a tertiary medical center after change in Medicare reimbursement
Am J Gastroenterol
(2003) - et al.
Are physicians less likely to recommend preventive services to low-SES patients?
Prev Med
(1997) The global burden of cancer
Semin Cancer Biol
(1998)Global cancer statistics in the year 2000
Lancet Oncol
(2001)- et al.
Screening for colorectal cancer on the front line
Am J Gastroenterol
(2003) - et al.
Cancer statistics, 2000
CA Cancer J Clin
(2000)
Cancer statistics, 2001
CA Cancer J Clin
Conceptual developments through colonoscopy
Surg Endosc
The Canadian Association of Gastroenterology position on colon cancer screening
Can J Gastroenterol
Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup
N Engl J Med
Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings
N Engl J Med
Cited by (23)
Canadian Colorectal Cancer Screening Initiatives and Barriers
2008, Journal of the American College of RadiologyCitation Excerpt :In contrast, Medicare beneficiaries in the United States must be older than 65 years. Thus, many individuals meet the criteria for screening colonoscopy but do not have medical insurance to cover the costs [58,59]. However, it is possible that more screening colonoscopies are being performed in the United States by primary care physicians who may not report their findings to the major teaching center databases, and therefore the results of the US studies may be lower than in actual practice.
Gender Disparities in Colorectal Cancer Screening: True or False?
2006, Journal of Gastrointestinal SurgeryCitation Excerpt :Although widely used, it remains largely unknown if survey data reflects true disparities in screening for many patient characteristics including gender. The overall gender disparity reported in previous survey-based, case-control, cohort studies was not demonstrated in the present study using such patient encounter claims data.1,7–9,11–15 Only a statistically insignificant decrease in overall screening rates of women compared with men was found.
Correlates of poor self-assessed health status among socially disadvantaged populations in Poland
2020, International Journal of Environmental Research and Public HealthDelivery of primary health care to persons who are socio-economically disadvantaged: Does the organizational delivery model matter?
2013, BMC Health Services ResearchA comparison of colorectal cancer screening uptake among average-risk insured American Indian/Alaska Native and white women
2013, Journal of Health Care for the Poor and Underserved