title: Different standards for healthy screenees than patients in routine clinics?
abstract: Less than 5% of colorectal adenomas will become malignant, but we do not have sufficient knowledge about their natural course to target removal of these 5% only. Thus, 95% of polypectomies are a waste of time exposing patients to a small risk of complications. Recently, a new type of polyps, sessile serrated polyps, has attracted attention. Previously considered innocuous, they are now found to have molecular similarities to cancer and some guidelines recommend to have them removed. These lesions are often flat, covered by mucous, not easily seen and situated in the proximal colon where the bowel wall is thinner. Thus, polypectomy carries a higher risk of perforation than predominantly left-sided, stalked adenomas - and we do not know what is gained in terms of cancer prevention. Screening is a neat balance between harms and benefit for presumptively healthy participants not interested in risk exposure to obtain confirmation of being healthy. The situation is quite different for patient worried about symptom. Thus, the standards set for evidence-based practice may be higher for screening than for routine clinics - a mechanism which may benefit patients in the long run.
authors.affiliation: Geir Hoff, Department of Research and Development, Telemark Hospital, 3710 Skien, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Hoff
mesh_terms: D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D058070:Asymptomatic Diseases; D003082:Colectomy / Q000009:adverse effects; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D003111:Colonic Polyps / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy / Q000592:standards*; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D008403:Mass Screening / Q000592:standards*; D009042:Motivation; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D019564:Unnecessary Procedures
keywords: Colonoscopy; Quality assurance; Screening; Standards