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Screening colonoscopies are overused
Question clinique
What proportion of screening colonoscopies for cancer are not performed according to guideline parameters?
L’Essentiel
From 17% to 25.7% of screening colonoscopies are performed too frequently or in patients who are too young or too old. In the United States alone, this rate translates into approximately 1 million colonoscopies performed each year outside of the parameters set by guidelines. As a reminder, screening via colonoscopy for colon cancer has never been shown to reduce overall mortality.
This POEM aligns with the Canadian Association of General Surgery’s Choosing Wisely Canada recommendation: Avoid colorectal cancer screening tests in asymptomatic patients with a life expectancy of less than 10 years and with no personal or family history of colorectal neoplasia.
1a-
Référence
Plan de l'etude: Systematic review
Financement: Foundation
Cadre: Various (meta-analysis)
Sommaire
These researchers searched 2 databases for English-language studies of screening colonoscopies for average-risk patients, identifying 6 studies with 242,756 screening colonoscopies. The studies defined colonoscopy overuse according to criteria from the US Preventive Services Task Force and the U.S. Multi-Society Task Force on Colorectal Cancer; that is, they are conducted in patients younger or older than the age range specified in national guidelines or at shorter intervals than recommended. The researchers followed PRISMA guidelines: 2 researchers selected articles for inclusion and 2 researchers independently abstracted data. These were all database studies. The studies reported 1 in 4 to 1 in 6 (17% to 25.7%) colonoscopies to be out of compliance with national guidelines.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Commentaires
Not surprising. What’s behind it?
It is possible that some of these average-risk screens may have had some mitigating factor not picked up on a chart review of 200,000 tests. But it is no doubt true that this coveted test is not always allocated perfectly. It would be interesting to know if the ‘inappropriate’ test subjects were of higher socioeconomic status. That group may have sway in getting what they want.
Screening Colonoscopies
'Screening for colon cancer by colonoscopy has never been shown to reduce overall mortality' .... is at odds with other literature.
Screening Colonoscopy
I was also wondering about this statement 'Screening for colon cancer by colonoscopy has never been shown to reduce overall mortality' - is this true?
colonoscopy
resource management
screening colonoscopies
make sure there is indication for scopes