title: Institutional commitment to rectal cancer screening results in earlier-stage cancers on diagnosis.
abstract: BACKGROUND
  The Veterans Administration hospitals underwent an institutional directive in 1998 to meet a colorectal cancer screening (CRCS) standard. This intervention should result in an increase in the hospital's screening rate and percentage of early-stage rectal cancers diagnosed.
  
  
  METHODS
  A retrospective review, from 1991 to 2002, of our institution's pathology and cancer registry databases for rectal cancers. CRCS data were obtained from the Veterans Administration Prevention Disease Index. Cancer stage at diagnosis was compared before and after the directive and was compared with the National Cancer Data Base and the Surveillance, Epidemiology, and End Results data.
  
  
  RESULTS
  The rate of CRCS was 55% in 1998 and increased to 75% in 2003. During the 11 years studied, a total of 147 rectal cancers were diagnosed. After the Veterans Administration directive, there was a significant increase in stage 0 cancers (P < .02) and an overall migration to earlier-stage cancers. Our Veterans Administration hospital had a significantly greater percentage of stage 0 cancers both before (P < .007) and after the directive (P < .00) and had fewer stage 3 cancers after the directive (P < .03) compared with National Cancer Data Base data. Compared with Surveillance, Epidemiology, and End Results data, the Palo Alto Veterans Affairs Health Care System had more local disease (P < .03) and less regional disease (P < .006).
  
  
  CONCLUSIONS
  These data suggest that a monitored institutional directive may significantly increase early detection of rectal cancers. This should result in a greater survival rate and lower local recurrence rate, because survival is predicated on stage at presentation. This may serve as a model for other health-care systems.
authors.affiliation: Department of Surgery, Stanford University, G112 PAVAHCS, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Battat
authors.forename: Robert V
authors.initials: RV
authors.lastname: Rouse
authors.forename: Lynne
authors.initials: L
authors.lastname: Dempsey
authors.forename: Bassem Y
authors.initials: BY
authors.lastname: Safadi
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Wren
mesh_terms: D000368:Aged; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012004:Rectal Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data*; D016019:Survival Analysis; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000706:statistics & numerical data*