Prevalence of advanced neoplasia at screening colonoscopy in men in private practice versus academic and Veterans Affairs medical centers.
OBJECTIVE
Several large population studies assessing the yield of average risk screening colonoscopy have evaluated Veterans Affairs (VA) populations. It remains uncertain how generalizable these findings are to men in the general population. The aim of this study was to define the prevalence of advanced neoplasia in male patients undergoing screening colonoscopy in diverse practice settings.


METHODS
The Clinical Outcomes Research Initiative (CORI) national endoscopic database was analyzed to compare the findings in men undergoing average risk screening colonoscopy in community, academic, and VA endoscopy settings.


RESULTS
Between January, 1998, and May, 2002, a total of 9109 men underwent screening colonoscopy in community (5625), academic (2269), and VA (1215) settings. Overall yield of colonic lesions (mass or polyp >9 mm) on average risk colonoscopy was 5.1%; 5.7% (community), 3.4% (academic), and 5.9% (VA) in each site, respectively. Among patients with lesions identified, multiple lesions >9 mm were less common in academic settings (6.4%) compared to community (12.0%) or VA (8.9%) sites. When adjusting for age and ethnicity on multivariate analysis, colonic lesion detection at VA sites was similar to community settings. However, lesion identification was more likely in both settings (VA: OR = 1.72; community: OR = 1.56) compared to academic centers.


CONCLUSIONS
Age- and race-adjusted prevalence of polyps >9 mm in men who receive screening colonoscopy was significantly lower in academic sites compared to VA and community practice sites. One must be cautious in generalizing the findings of male patient studies from academic centers to the entire population.
Harewood
Gavin C
GC
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Lieberman
David A
DA
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D019538:Health Care Surveys; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011331:Private Practice; D014481:United States / Q000453:epidemiology