NCPA - National Center for Policy Analysis

TOO MANY COLONOSCOPIES

August 19, 2004

Doctors may be performing too many colonoscopies, a test used to screen for colon cancer, according to a study by researchers at the National Cancer Institute, part of the National Institutes of Health.

Researchers surveyed more than 600 surgeons and gastroenterologists and found that they were likely to perform follow-up colonoscopies more often than called for in practice guidelines for patients who had benign polyps and other abnormalities removed. Depending on the type of benign polyp removed, the current professional guidelines call for a follow-up colonoscopy either at three or five years, or not at all.

  • The findings suggest widespread "overuse" of follow-up colonoscopies, which "threatens to overwhelm the money and resources available for health-care maintenance." Colonoscopies cost about $1,600.
  • Martin Brown, one of the study's co-authors, said there are no clear health benefits to a more intensive colonoscopy follow-up.

The study also found:

  • In the lowest-risk scenario, in which a patient had a hyperplastic polyp removed, 24 percent of gastroenterologists and 54 percent of surgeons would recommend a colonoscopy at least every five years.
  • However, researchers say that people who have had hyperplastic polyps removed don't have a higher risk of developing colon cancer and don't need a follow-up colonoscopy.

Among those patients with a single, small adenoma -- which is considered a low-risk abnormality -- researchers found that one-half of physicians surveyed would recommend repeat colonoscopy every three years or sooner, when guidelines suggest follow up every three to five years.

Researchers noted that physicians have other less-involved tests that can be performed to screen for colon problems.

Source: Jennifer Corbett Dooren, "Colonoscopy May Be Overused As Follow-up to Some Surgery," Wall Street Journal, August 18, 2004; and Martin Brown, et al. "Are physicians overperforming colonoscopy? A national survey of colorectal surveillance after polypectomy," Annals of Internal Medicine, vol. 141 (4), Aug 17, 2004.

For text (Subscription required) http://online.wsj.com/article/0,,SB109277796324794005,00.html

For study http://www.cancer.gov/newscenter/pressreleases/OverperformanceColonoscopy

 

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