Study: Fast Colonoscopies Miss Growths

Saw this article and thought you guys would find it interesting:

Tell your doctor to take his time during your next colonoscopy. Those who spent less than the recommended six minutes on the crucial part of the exam found one-fourth as many precancerous growths than those who lingered longer with the scope, a study found.

It involved thousands of exams done by 12 doctors in a large private gastroenterology practice in Rockford, Ill. Doctors who spent the most time found 10 times more growths than those who zipped fastest through the procedure, said Dr. Robert Barclay, who led the study and published results in Thursday's New England Journal of Medicine.

"We were surprised at the magnitude of the differences among the colonoscopists in our group," he said.

Most doctors are probably not tracking how long they take or how many growths they find, said Dr. Douglas Rex, chief of endoscopy at Indiana University and a spokesman for the American College of Gastroenterology.

"It's a reasonable thing for people to start asking their doctor," he recommended. "Say: 'I want you to be really careful and slow in examining my colon.'"

Colonoscopy is the gold standard test to screen for colon cancer, which will strike nearly 150,000 Americans this year and kill more than 55,000.

While the patient is sedated for the exam - typically less than half an hour - a doctor puts a thin, flexible tube into the bowel. As the lighted scope is slowly withdrawn, the doctor looks for growths called polyps. These can take a decade to form and turn cancerous, so finding them early is one of the best ways to prevent the disease and improve the odds of surviving it.

Barclay and others at the University of Illinois College of Medicine and Rockford Gastroenterology Associates analyzed 7,882 colonoscopies done on their patients over 15 months, including 2,053 first-time screening exams. They clocked how long doctors took to withdraw the scope and compared it to the number, size and type of polyps detected.

Polyps were found in more than 28 percent of patients whose doctors took an average of six minutes or more but in only 12 percent of patients whose doctors went faster. Detection of the most serious types of growths also differed - 6 percent in slower exams versus almost 3 percent.

Previous research suggests that at least 25 percent of men and 15 percent of women ages 50 and older will have one or more polyps, Rex said. Guidelines he helped write for several professional associations recommend that doctors spend at least six minutes on scope withdrawal to help ensure they are not missing a potential cancer.

In an editorial in the journal, Dr. David Lieberman of Oregon Health and Science University in Portland praised the Rockford doctors for examining their own practice to try to improve performance of an important cancer test.

"There is a lesson here for every practitioner in every specialty," he wrote. Research on quality of care should not just be done by big universities, "but also needs to be part of the culture of everyday clinical practice."

Cancer specialists recommend colonoscopies every 10 years for people 50 and older at average risk of colon cancer. Medicare and most insurers cover the exam. Other tests that look for blood in the stool and an exam called flexible sigmoidoscopy also can be used for cancer screening, but must be done more often.

Symptoms of colon cancer can include blood in the stool, changes in bowel habits, or unexplained weight loss or abdominal pain.