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PubMed2002

Change in anatomic distribution and incidence of colorectal carcinoma over a period of 15 years: clinical considerations.

PURPOSE: Colorectal cancer is the second most common cancer in the Netherlands. Its incidence rates are among the highest in Europe. In the past decades, a right-sided shift of the subsite location of colorectal cancer has been reported. These changes in anatomic distribution might have clinical implications for the use of diagnostic or screening tools for colorectal cancer. This study was designed to investigate the change in incidence and anatomic distribution of colorectal cancer in a population over a period of 15 years. METHODS: The incidence of colorectal cancer in an eastern part of the Netherlands (700,000 inhabitants) was determined for two years, 1981 and 1996. From the regional laboratory of pathology, data including age, gender, subsite location, and Dukes classification were collected. The subsite location of colorectal cancer was divided into two groups: proximal and distal (the latter being within sigmoidoscopy reach). RESULTS: No differences in age and gender distribution were found. In 1981, the diagnosis of colorectal cancer was made in 232 patients in this region, and in 1996, it was made in 410 patients. The population remained almost stable during this time. Therefore, the incidence rose from 33 to 55 per 100,000 inhabitants from 1981 to 1996, respectively. In 1981, 25 percent of the carcinomas were proximal (to the sigmoid colon); this increased to 37 percent in 1996 ( P< 0.05). CONCLUSIONS: The incidence of colorectal cancer has almost doubled from 1981 to 1996 in this Dutch region. The proportion of proximal colorectal cancer has increased from 25 to 37 percent. These findings add to the notion that sigmoidoscopy is not the optimal diagnostic or screening tool for colorectal cancer.

Aged↗

PubMed2006

Risk of advanced proximal adenoma and cancer according to rectosigmoid findings in the Korean population.

Colorectal cancer is one of the leading causes of cancer death in the United States and Europe. Recently, the incidence of colorectal cancer has been increasing remarkably in Korea. To reduce the high incidence, screening of colorectal cancer in asymptomatic individuals has been advocated. Sigmoidoscopy is simpler, faster, and better tolerable than total colonoscopy, but the scope cannot reach the proximal colon segment and, therefore, may miss proximal colon cancer. In the present study, we intended to investigate the prevalence of proximal adenoma and cancer according to the findings in rectosigmoid colon and to find their risk factors. Data were collected retrospectively from 1541 consecutive patients who underwent total colonoscopy at the Department of Gastroenterology, Hanyang University, between October 2003 and December 2004. Neoplasms were classified as diminutive adenoma (< or =5 mm), small adenoma (6-9 mm), advanced adenoma (> or =10 mm, with villous component or high-grade dysplasia), and cancer. The sites of neoplasms were defined as rectosigmoid (rectum and sigmoid colon) and proximal (from cecum to descending colon) colon. The prevalence of advanced proximal adenoma was associated with severe rectosigmoid findings. On the other hand, the prevalence of proximal colon cancer did not show such a tendency. Among the 131 patients with proximal advanced adenoma, 66% had no neoplasm in the rectosigmoid colon. Moreover, among the 27 patients with proximal cancer, 52% had no neoplasm in the rectosigmoid colon. Multivariate logistic regression analysis revealed that age, gender, and advanced rectosigmoid adenoma were the risk factors of advanced proximal adenoma, but nothing was associated with the risk for proximal colon cancer. Advanced rectosigmoid adenoma may be the predictor of advanced proximal adenoma, especially in old males. However, nothing is related to the risk for proximal colon cancer. Therefore, colonoscopy may be more adequate for colorectal cancer screening than sigmoidoscopy in the Korean population.

Adenoma↗

PubMed1986

Solitary colonic ulcer in a spinal cord injured patient.

Bleeding from the lower gastrointestinal tract is rarely reported in spinal cord injured patients. A case is reported of such bleeding in a quadriplegic man with a solitary colonic ulcer diagnosed by flexible sigmoidoscopy and biopsy. The diagnosis of solitary colonic ulcers is difficult to make in spinal cord injured persons because presenting features may be masked by the neurologic deficits caused by the injury or may be falsely attributed to problems associated with the injury or to iatrogenic trauma. Solitary colonic ulcer should be included in the differential diagnosis of gastrointestinal bleeding in persons with spinal cord injury. Flexible sigmoidoscopy or colonoscopy is recommended for visualization and biopsy of the bleeding lesion.

Adult↗

PubMed2004

Effect of oral sucralfate on late rectal injury associated with radiotherapy for prostate cancer: A double-blind, randomized trial.

PURPOSE: To assess whether oral sucralfate is effective in preventing late rectal injury in prostate cancer patients treated with radiotherapy. METHODS AND MATERIALS: A double-blind, placebo-controlled, randomized trial was conducted across four institutions in Australia. Patients receiving definitive radiotherapy for prostate cancer were randomized to receive either 3 g of oral sucralfate suspension or placebo twice daily. Data on patients' symptoms were collected for 2 years, and flexible sigmoidoscopy was scheduled at 12 months after treatment. RESULTS: A total of 338 patients were randomized, of whom 298 had adequate follow-up data available for an analysis of late symptoms. Of the 298 patients, 143 were randomized to receive sucralfate and 155 placebo. The cumulative incidence of Radiation Therapy Oncology Group Grade 2 or worse late rectal toxicity at 2 years was 28% for placebo and 22% for the sucralfate arm (p = 0.23; 95% confidence interval for the difference -3% to 16%). Seventeen percent of patients in the sucralfate group had significant bleeding (Grade 2 or worse) compared with 23% in the placebo group (p = 0.18, 95% confidence interval -15% to 3%). No statistically significant difference was found between the two groups with respect to bowel frequency (p = 0.99), mucus discharge (p = 0.64), or fecal incontinence (p = 0.90). Sigmoidoscopy findings showed a nonstatistically significant reduction in Grade 2 or worse rectal changes from 32% with placebo to 27% in the sucralfate group (p = 0.25). CONCLUSION: This trial demonstrated no statistically significant reduction in the incidence of late rectal toxicity in patients randomized to receive sucralfate. However, this result was considered inconclusive, because the trial was unable to exclude clinically important differences in the late toxicity rates.

Adult↗

PubMed2006

Evolving practice patterns in colon and rectal surgery.

BACKGROUND: Minimum numbers of cases required for certification by the American Board of Colon and Rectal Surgery (ABCRS) have been determined from a prospective database of all applicants applying for examination since 1989. These data represent the longitudinal evolution of practice patterns in tertiary colorectal training programs. STUDY DESIGN: After obtaining permission from the ABCRS, access to the database was obtained and data from the 12-year period 1994 to 2005 were analyzed. RESULTS: The database contains the operative and endoscopic case numbers of 673 residents. The number of training programs increased from 28 to 39 (28%) and the number of residency positions from 50 to 66 (24%). Median numbers of anorectal patients per resident remained remarkably constant over the period of study. Both rigid sigmoidoscopy (67 to 44 per resident) and flexible sigmoidoscopy (135.5 to 39 per resident) decreased substantially; colonoscopy volume increased (209 to 264 per resident). Perineal procedures for rectal prolapse consistently comprise 50% to 60% of the total procedures for prolapse. Low anterior resection for rectal cancer outnumber abdominoperineal resections by a 3/1 ratio. Coloanal anastomoses have steadily increased. Laparoscopic approaches for all abdominal operations have increased substantially, with the greatest increase being in diverticular resections (6.5% to 44.7%). CONCLUSIONS: Prospective data collection by ABCRS has permitted calculation of minimum numbers of operative cases for training colorectal surgeons, with the advantage of a rolling average that reflects evolving practice patterns in teaching programs. Analysis of these data allows planning of needs-based educational programs and may ultimately be involved in designing the maintenance of certification process.

Anal Canal↗

PubMedDate not supplied

Colorectal cancer screening behavior in women attending screening mammography: longitudinal trends and predictors.

PURPOSE: Nationally representative surveys demonstrate that the adherence to screening mammography guidelines are associated with increased prevalence of colorectal cancer (CRC) screening; however, the incidence of CRC screening in the screening mammography population is unknown. Our purpose was to describe non-fecal occult blood test (FOBT) CRC screening utilization by women prior to and subsequent to screening mammography at a large academic medical center. MATERIALS AND METHODS: Using the institutional administrative data base, 17,790 women aged 50 and older who underwent screening mammography between 1998 and 2002 were retrospectively identified. We determined that women were current with non-FOBT CRC screening at the time of mammography if they had undergone flexible sigmoidoscopy or double-contrast barium enema in the 5 years or colonoscopy since 1995, the earliest for which data are available. We excluded FOBT as a form of CRC screening because the administrative data base did not adequately capture episodes of FOBT. Women who were not current were considered eligible for non-FOBT CRC screening. We then assessed the number of women who underwent flexible sigmoidoscopy, barium enema, or colonoscopy within 12 months following mammography. Age, insurance status, Breast Imaging Reporting and Data System classification, recommendations after screening mammography and year of mammography were examined as potential predictors of non-FOBT CRC screening completion. RESULTS: At the time of mammography, 13.3% women were current with non-FOBT CRC screening. Of women eligible for non-FOBT CRC screening at the time of mammography, 1.1% completed non-FOBT CRC screening within 12 months after mammography. The rate of non-FOBT CRC screening completion increased over time. After multivariate analysis, being insured by a commercial managed care organization or by Medicaid remained significant predictors of non-FOBT CRC screening. CONCLUSION: The prevalence of non-FOBT CRC screening is low in the population of women undergoing screening mammography, with an incidence of 1.0%. Future studies should examine whether delivering CRC screening interventions at a screening mammography visit increase adherence to non-FOBT CRC screening.

Aged↗

PubMed2004

Colorectal cancer screening, 1997-1999: role of income, insurance and policy.

BACKGROUND: Receipt of age-appropriate cancer screens can lead to reduced incidence and mortality. Yet, low-income and uninsured experience barriers to screening. This paper examines colorectal cancer rates by income, racial and insured groups 1997 and 1999. These years focus on changes pre/post a 1998 policy change for Medicare beneficiaries that reduced their out-of-pocket costs for colorectal screening. METHODS: The 1997 and 1999 Behavioral Risk Factor Surveillance System (BRFSS) survey is used to examine changes in age-appropriate fecal-occult blood testing (FOBT), flexible sigmoidoscopy screens. Differences in the odds that Medicare beneficiaries, relative to private insured, receive screens pre/post 1998 are examined using multivariate logit models. RESULTS: Average rates of sigmoidoscopy increased significantly during 1997-1999 but remain below desired levels. While Medicare beneficiaries are more likely than privately insured to be screened, gaps between low- versus high-income groups in both Medicare and non-Medicare populations remain. The 1998 Medicare policy change was associated with a significant increase in the odds of screening among low-income (<$25,000) Medicare beneficiaries. CONCLUSIONS: Policy makers should consider reasons for continued low colorectal screening rates among all insured groups. Barriers such as patient perceptions and physician advice should be considered along with the vulnerability that low income and lack of insurance imposes.

Colorectal Neoplasms↗

PubMed2003

Current capacity for endoscopic colorectal cancer screening in the United States: data from the National Cancer Institute Survey of Colorectal Cancer Screening Practices.

PURPOSE: There is a national goal in the United States to increase the level of colorectal cancer screening, but there is currently little information on resources for the delivery of endoscopic screening and follow-up diagnostic and surveillance procedures. The purpose of this study was to provide nationally representative data on endoscopic resources at the provider level. METHODS: A nationally representative survey of primary care physicians, general surgeons, and gastroenterologists that was conducted during 1999 to 2000 provided data from survey responses by 1235 primary care physicians, 349 gastroenterologists, and 316 general surgeons. RESULTS: We estimated that 65% of all sigmoidoscopy procedures were performed by primary care physicians, 25% by gastroenterologists, and 10% by general surgeons. Only 30% of all primary care physicians performed any procedures, and average volume among those who did was relatively low (seven per month). Gastroenterologists performed two thirds of all colonoscopy procedures, with most of the remainder performed by general surgeons. CONCLUSION: There is potential to increase the capacity to perform screening sigmoidoscopy procedures through primary care delivery. However, without careful consideration of organizational factors, this could result in increased cost and quality control problems. Increasing the capacity for screening colonoscopy is feasible, but will require attention to other problems, such as avoiding overfrequent (e.g., annual or biennial) procedures in low-risk patients.

Academies and Institutes↗

PubMed1999

Screening guidelines for colorectal cancer.

Evidence-based guidelines recommend that all asymptomatic, average-risk U.S. citizens >50 years of age be encouraged to undergo screening for colorectal cancer. Those at higher risk should be offered more intensive screening and follow-up surveillance. It is estimated that widespread adoption of these recommendations could reduce mortality from colorectal cancer by >50%. The only screening methods that have been evaluated directly are the fecal occult blood test and flexible sigmoidoscopy. Current guidelines now recommend annual screening for fecal occult blood plus flexible sigmoidoscopy every 5 years for asymptomatic, average-risk men and women >50 years of age. Indirect evidence supports the options of colonoscopy or barium enema x-ray screening for highly motivated individuals, but these methods have not yet been tested in prospective trials. In the future, gene-based screening tests may be developed, and computed tomography of the colon ("virtual colonoscopy") may prove effective and feasible.

Age Factors↗

PubMed1988

Endoscopy versus double-contrast barium enema in the evaluation of patients with symptoms suggestive of colorectal carcinoma.

Two hundred seventy-six patients with positive findings on a stool guaiac test, hematochezia, a change in bowel habits, or a family history of colorectal carcinoma were referred to the colorectal clinic for further investigation. There were 105 men and 171 women. All patients underwent examination with the 65 cm flexible sigmoidoscope. Patients with no abnormalities on endoscopy underwent a double-contrast barium enema. If the barium enema revealed a polyp or other suspicious pathologic process, the patient was referred for colonoscopy. In 258 patients, findings of barium enema and flexible sigmoidoscopy were in agreement. The findings in 178 of these examinations were completely negative, and in the remaining 80 cases flexible endoscopy and barium enema revealed diverticulosis. In an additional 18 patients, negative findings on flexible sigmoidoscopy were followed by positive findings on barium enema. Thirteen of these 18 patients (72 percent) had negative findings on colonoscopies and therefore had false-positive findings on barium enema. In the remaining five patients (28 percent), an unsuspected colonic carcinoma or premalignant polyp was discovered on barium enema and documented by colonoscopy. Also, in four of these five patients, colonoscopy found additional polyps that were not seen on barium enema.

Barium Sulfate↗

PubMed1999

A retrospective 5-year study on the accuracy of the barium enema examination performed by radiographers.

Barium enema examinations have been undertaken by radiographers at the Frenchay Hospital for more than 10 years. We have performed a retrospective study to assess the accuracy of this radiographer service by reviewing those patients who have been examined by both Barium enema and colonoscopy/flexible sigmoidoscopy to determine agreement, and reasons for disagreement. This paper does not attempt to compare the two techniques. In the 5 years between 1992 and 1996, 595 patients had both barium enema and colonoscopy or flexible sigmoidoscopy. In 488 (82%) of these patients the barium enema examination was performed by a radiographer. Comparisons with endoscopy indicate that 96% of polyps >1 cm, and 97% of carcinomas were detected radiologically. We conclude that radiographer performed barium enemas with double reporting produces a very high standard of examination with detection rates for significant lesions comparable with published data.

Barium Sulfate↗

PubMed2000

Patterns of endoscopy use in the United States.

BACKGROUND & AIMS: The aim of this study was to use a large national endoscopic database to determine why routine endoscopy is performed in diverse practice settings. METHODS: A computerized endoscopic report generator was developed and disseminated to gastrointestinal (GI) specialists in diverse practice settings. After reports were generated, a data file was transmitted electronically to a central databank, where data were merged from multiple sites for analysis. RESULTS: From April 1, 1997, to October 28, 1998, 276 physicians in 31 practice sites in 21 states provided 18,444 esophagogastroduodenoscopy (EGD) reports, 20,748 colonoscopy reports, and 9767 flexible sigmoidoscopy reports to the central databank. EGD was most commonly performed to evaluate dyspepsia and/or abdominal pain (23.7%), dysphagia (20%), symptoms of gastroesophageal reflux without dysphagia (17%), and suspected upper GI bleeding (16.3%). Colonoscopy was most often performed for surveillance of prior neoplasia (24%) and evaluation of hematochezia (19%) or positive fecal occult blood test (15%). Flexible sigmoidoscopy was most commonly performed for routine screening (40%) and evaluation of hematochezia (22%). There were significant differences between academic and nonacademic sites. CONCLUSIONS: The endoscopic database can be an important resource for future research in endoscopy by documenting current practice patterns and changes in practice over time.

Colonoscopy↗

PubMed2004

[Population screening for colorectal cancer: a systematic review].

INTRODUCTION: Colorectal cancer (CRC) is a serious public health problem due to its high frequency and the mortality it provokes. This disease presents a series of characteristics that make it an ideal candidate for population screening. The aim of the present study was to analyze current knowledge on the efficacy/effectiveness of CRC screening through the fecal occult blood test (FOBT), rectosigmoidoscopy and colonoscopy in individuals without symptoms of this disease. METHOD: We performed a systematic review of the literature on each of the methods of early detection. The databases consulted were MEDLINE and PREMEDLINE (1966-2002), Embase (1980-2002), HTA and Cochrane, among others. Articles were selected using explicit criteria and were classified according to their level of scientific evidence. RESULTS: The best validated test is the FOBT, with the greatest number of randomized controlled trials. The results on the sensitivity and specificity of this test and reduction in mortality from CRC varied widely, depending on the technique used. The decrease in mortality from CRC in groups that underwent screening through FOBT was between 15% and 33%. The number and quality of the studies performed to evaluate flexible sigmoidoscopy and colonoscopy as methods of early detection were much lower. Although the rate of detection of polyps is greater than with the FOBT, the value of these tests as screening techniques has not been analyzed through randomized controlled trials. CONCLUSION: Population screening for CRC reduces mortality from this disease. However, consensus is lacking on the screening method of choice and on the frequency with which screening should be performed. The method best supported by the evidence as a primary detection test is the FOBT. To date, sigmoidoscopy and colonoscopy should be used as diagnostic tests only, mainly because of their invasiveness.

Clinical Trials as Topic↗

PubMed2003

Cancer screening estimates for U.S. metropolitan areas.

OBJECTIVES: To provide estimates of breast, cervical, and colorectal cancer screening for metropolitan areas in the United States. METHODS: Behavioral Risk Factor Surveillance System (BRFSS) data from 1997 to 1999 were reweighted and analyzed for 69 U.S. metropolitan areas for the receipt of a Papanicolaou (Pap) test (ages > or =18 years); mammography (ages > or =40 years); fecal occult blood testing and sigmoidoscopy (ages > or =50 years). Stratified analyses by demographics were performed for 25 metropolitan areas with populations of > or =1.5 million. RESULTS: Metropolitan estimates ranged from 64.6% to 82.0% for mammography and from 77.2% to 91.7% for Pap tests. There was much greater variability in estimates for colorectal cancer screening, with a 3.6-fold difference in the range of estimates for fecal occult blood testing (9.9% to 35.2%) and a 2.5-fold difference for sigmoidoscopy (17.3% to 43.3%). In the 25 largest areas, prevalence of cancer screening was generally lower for persons with a high school education or less and for those without health insurance. Compared with women aged 50 to 64 years, mammography estimates were lower for women aged 40 to 49 years in 13 of the 25 metropolitan areas. Pap testing was less common among women aged > or =65 years, and colorectal cancer screening was less common for persons aged 50 to 64 years. CONCLUSIONS: Estimates of cancer screening varied substantially across metropolitan areas. Increased efforts to improve cancer screening are needed in many urban areas, especially for colorectal cancer screening. The BRFSS is a useful, inexpensive, and timely resource for providing metropolitan-area cancer screening estimates and may be used in the future to guide local or county-level screening efforts.

Adult↗

PubMed2002

Cost-effectiveness of screening the average-risk population for colorectal cancer.

This article reviews several of the recent models addressing the cost-effectiveness of colorectal cancer screening in the average-risk individual (Table 1). How can clinicians and policy makers use this information for decision making regarding colorectal cancer screening? The cost-effectiveness ratios reported by themselves do not identify cost-effective practices. They must be placed in a decision context that is expressed in one of two forms. In the first form, an explicit threshold or maximum amount that a policy maker is willing to spend is stated (e.g., $40,000 per LY gained, as has been quoted as an acceptable amount for a prevention program). In the second form of decision context, a list of medical practices and their associated cost-effectiveness ratios, also known as a league table (Table 2) is used as a basis for comparison with the practice under evaluation (e.g., colorectal cancer screening). The practice with the lowest cost-effectiveness ratio is the most cost-effective practice on the list. Practices with lower cost-effectiveness ratios are considered cost-effective compared with those with higher ratios. Table 2 lists incremental cost-effectiveness ratios for common medical practices. The models discussed in this article suggested that colorectal cancer screening using annual FOBT, flexible sigmoidoscopy at 3 or 5 years, the combination of FOBT and flexible sigmoidoscopy, barium enema, colonoscopy, and even virtual colonoscopy had incremental cost-effectiveness ratios ranging from $6300 to $92,900 per LY saved with most of the cost-effectiveness ratio ranging from $10,000 to $40,000 per LY saved. These ratios are similar to the cost of another widely accepted practice, breast cancer screening with annual mammography in women age 50 and older ($22,000 per LY gained). Colorectal cancer screening with any of the modalities discussed is considered less cost-effective than screening for hemochromatosis, which has an incremental cost-effectiveness ratio of $3665 per LY saved. Based on these ratios, however, screening for colorectal cancer is considered cost-effective compared with cervical cancer screening in women age 20 and older with pap smear every 3 years, which has an incremental cost-effectiveness ratio of $250,000 per LY gained. The clinician can use these incremental cost-effectiveness ratios to evaluate the risks and benefits of alternative practices for the individual, and the policy maker with a limited health care budget can use these ratios to set priorities for funding based on the costs and the expected gains in life expectancy for colorectal cancer screening and for alternative health care programs.

Colonoscopy↗

PubMed2003

Predictive value of diminutive colonic adenoma trial: the PREDICT trial.

BACKGROUND & AIMS: Diminutive adenomas (1-9 mm in diameter) are frequently found during colon cancer screening with flexible sigmoidoscopy (FS). This trial assessed the predictive value of these diminutive adenomas for advanced adenomas in the proximal colon. METHODS: In a multicenter, prospective cohort trial, we matched 200 patients with normal FS and 200 patients with diminutive adenomas on FS for age and gender. All patients underwent colonoscopy. The presence of advanced adenomas (adenoma >or= 10 mm in diameter, villous adenoma, adenoma with high grade dysplasia, and colon cancer) and adenomas (any size) was recorded. Before colonoscopy, patients completed questionnaires about risk factors for adenomas. RESULTS: The prevalence of advanced adenomas in the proximal colon was similar in patients with diminutive adenomas and patients with normal FS (6% vs. 5.5%, respectively) (relative risk, 1.1; 95% confidence interval [CI], 0.5-2.6). Diminutive adenomas on FS did not accurately predict advanced adenomas in the proximal colon: sensitivity, 52% (95% CI, 32%-72%); specificity, 50% (95% CI, 49%-51%); positive predictive value, 6% (95% CI, 4%-8%); and negative predictive value, 95% (95% CI, 92%-97%). Male gender (odds ratio, 1.63; 95% CI, 1.01-2.61) was associated with an increased risk of proximal colon adenomas. CONCLUSIONS: Diminutive adenomas on sigmoidoscopy may not accurately predict advanced adenomas in the proximal colon.

Adenoma↗

PubMed2004

Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population in the United States?

BACKGROUND & AIMS: Screening rates for colorectal cancer remain low compared with screening rates for other cancers. The size of the unscreened population and the capacity to provide widespread screening are unknown. We estimated the number of average-risk persons aged 50 years or older not screened for colorectal cancer, the number of procedures required for this population, and the endoscopic capacity to satisfy this unmet need. METHODS: Using data from the US Census Bureau and the Centers for Disease Control and Prevention's National Health Interview Survey, we designed a forecasting model to estimate the number of persons in the United States currently not screened for colorectal cancer and the number of examinations needed to screen these persons. Test need was compared with available capacity, based on results from the national Survey of Endoscopic Capacity, assuming different proportions of available capacity were used for colorectal cancer screening. RESULTS: Approximately 41.8 million average-risk people aged 50 years or older have not been screened for colorectal cancer according to national guidelines. Sufficient capacity exists to screen the unscreened population within 1 year using fecal occult blood testing followed by diagnostic colonoscopy for positive tests. Depending on the proportion of available capacity used for colorectal cancer screening, it could take up to 10 years to screen the unscreened population using flexible sigmoidoscopy or colonoscopy. CONCLUSIONS: The capacity exists for widespread screening with fecal occult blood testing. The capacity for screening with flexible sigmoidoscopy or colonoscopy depends on the proportion of available capacity used for colorectal cancer screening.

Aged↗

PubMed2000

Sex and familiarity of colonoscopists: patient preferences.

BACKGROUND AND STUDY AIMS: The gender preference of patients for doctors has been noted in many areas of medicine, but has never been studied in those undergoing the potentially embarrassing procedures of colonoscopy and sigmoidoscopy. We were interested in whether patients did express a preference for either the sex of a doctor, or a doctor whom they had previously met, so that we might in future consider offering a choice of endoscopist. PATIENTS AND METHODS: A total of 101 patients attending for colonoscopy or flexible sigmoidoscopy were prospectively asked to complete an anonymous questionnaire enquiring about gender preference and preference for an endoscopist with whom they were familiar. The questionnaire also asked about the patient's age and whether patients felt sufficiently strongly about their choice that they would be prepared to wait longer for the procedure if necessary. RESULTS: The response rate for completion of the questionnaire was 100% (65 female patients and 34 male patients, with two patients not disclosing their sex). Among the female patients, 48% preferred a female colonoscopist, whereas no male patients preferred a male colonoscopist (chi2 = 26.8, df = 2; P < 0.0001). Women also felt more strongly about seeing a familiar colonoscopist, with 56% of women and 35% of men preferring the same doctor they had seen in the outpatient department to perform the test (chi2 = 21.2, df = 2, P < 0.0001). CONCLUSION: By offering the choice of a female endoscopist to female patients, and a doctor that the patient has already met in the outpatient department to perform the procedure, the stress of lower gastrointestinal endoscopy might be minimized. This might reduce the proportion of patients failing to attend for booked procedures and thereby increase both the detection of serious pathology and the efficiency of the endoscopy unit.

Attitude↗