Utilization of surveillance colonoscopy in community practice.
OBJECTIVE
The recommended timing of surveillance colonoscopy for individuals with adenomatous polyps is based on adenoma histology, size, and number. The burden and cost of surveillance colonoscopy are significant. The aim of this study was to examine the use of surveillance colonoscopy on a community-wide basis.


METHODS
We retrospectively queried participants in the Prostate, Lung, Colorectal, and Ovarian Cancer screening trial in 9 US communities about use of surveillance colonoscopy. Subjects whose initial colonoscopy showed advanced adenoma (AA), nonadvanced adenoma (NAA), or no adenoma (NA) findings were included. Colonoscopy examinations were confirmed by reviewing colonoscopy reports.


RESULTS
Of 3876 subjects selected for inquiry, 3627 (93.6%) responded. The cumulative probability of a surveillance colonoscopy within 5 years was 58.4% (n = 1342) in the AA group, 57.5% in those with >or=3 NAAs (n = 117), 46.7% in those with 1-2 NAAs (n = 905), and 26.5% (n = 1263) in subjects with NAs. Within 7 years, 33.2% of subjects with AAs received >or=2 surveillance examinations versus 26.9% for those with >or=3 NAAs, 18.2% for those with 1 or 2 NAAs, and 10.4% for those with NAs. Incomplete colonoscopy, family history of colorectal cancer, or interval adenomatous findings could explain only a minority of surveillance colonoscopy in low-risk subjects.


CONCLUSIONS
In community practice, there is substantial overuse of surveillance colonoscopy among low-risk subjects and underuse among subjects with AAs. Interventions to better align use of surveillance colonoscopy with risk for advanced lesions are needed.
Schoen
Robert E
RE
Department of Medicine, University of Pittsburgh Medical Center, and University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15213-2582, USA. rschoen@pitt.edu
Pinsky
Paul F
PF
Weissfeld
Joel L
JL
Yokochi
Lance A
LA
Reding
Douglas J
DJ
Hayes
Richard B
RB
Church
Timothy
T
Yurgalevich
Susan
S
Doria-Rose
V Paul
VP
Hickey
Tom
T
Riley
Thomas
T
Berg
Christine D
CD
D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology*; D018256:Adenomatous Polyps / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D003113:Colonoscopy / Q000706:statistics & numerical data*; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005762:Gastroenterology / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology