title: Utilization of surveillance colonoscopy in community practice.
abstract: 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.
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, and University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15213-2582, USA. rschoen@pitt.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schoen
authors.forename: Paul F
authors.initials: PF
authors.lastname: Pinsky
authors.forename: Joel L
authors.initials: JL
authors.lastname: Weissfeld
authors.forename: Lance A
authors.initials: LA
authors.lastname: Yokochi
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Reding
authors.forename: Richard B
authors.initials: RB
authors.lastname: Hayes
authors.forename: Timothy
authors.initials: T
authors.lastname: Church
authors.forename: Susan
authors.initials: S
authors.lastname: Yurgalevich
authors.forename: V Paul
authors.initials: VP
authors.lastname: Doria-Rose
authors.forename: Tom
authors.initials: T
authors.lastname: Hickey
authors.forename: Thomas
authors.initials: T
authors.lastname: Riley
authors.forename: Christine D
authors.initials: CD
authors.lastname: Berg
mesh_terms: 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