title: Evaluating screening age for colonoscopy: a quality assurance assessment.
abstract: OBJECTIVE
  To evaluate colonoscopies in patients aged 40 to 49 and 50 to 59 years from multiple endoscopy surgery centers serving a wide geographical area.
  
  
  METHODS
  An observational prospective multicenter quality assurance review was conducted in 49 Ambulatory Surgery Centers in 17 states with 315 gastroenterologists. Care of patients and routine of gastroenterologists continued as standard practice with patients attending for purposes of screening, surveillance, and symptoms.
  
  
  RESULTS
  There were 1688 and 5090 consecutive qualified patients aged 40 to 49 and 50 to 59 years, respectively, receiving colonoscopies in a designated 4 week period. There was no significant difference (P=0.55) in the screening category between ages 40 to 49 (n=420) and 50 to 59 years (n=2705) in incidence of colon polyps although the older age group had more than 6 times the number of patients than the younger age group. Age group of 40 to 49-year-old males (21.5%) are at similar risk to 40 to 49-year-old females (21.1%) in development of carcinoma and adenoma polyps combined. Age group of 50 to 59-year-old males (31.3%) appear at greater risk (P<0.0001) than age 50 to 59-year-old females (18.4%) in development of carcinoma and adenoma polyps combined in the screening category. For surveillance and symptom categories significant differences (P<0.05) occurred between both age groups 40 to 49 and 50 to 59 years for males but not females in development of carcinoma and adenoma polyps combined.
  
  
  CONCLUSIONS
  The equal risk of colon polyps in screening colonoscopies for age 40 to 49 and 50 to 59 years suggest reexamination of current recommendations for 50 years as the beginning age for screening colonoscopy. Further studies are needed to examine sex differences and cost effectiveness of screening colonoscopies beginning at age 40 years and to explore these factors as well in surveillance and symptom categories.
authors.affiliation: Corporate Risk Management, AMSURG, Nashville, TN, USA. bfoverholt@gihealthcare.com
authors.forename: Bergein F
authors.initials: BF
authors.lastname: Overholt
authors.forename: Linda
authors.initials: L
authors.lastname: Brooks-Belli
authors.forename: Michael G
authors.initials: MG
authors.lastname: Grace
authors.forename: Kristin
authors.initials: K
authors.lastname: Rankin
authors.forename: Royce
authors.initials: R
authors.lastname: Harrell
authors.forename: Mary
authors.initials: M
authors.lastname: Turyk
authors.forename: Fred B
authors.initials: FB
authors.lastname: Rosenberg
authors.forename: Robert W
authors.initials: RW
authors.lastname: Barish
authors.forename: Norman H
authors.initials: NH
authors.lastname: Gilinsky
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D000367:Age Factors; D003111:Colonic Polyps / Q000175:diagnosis* / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D012737:Sex Factors