Overuse of Colonoscopy for Colorectal Cancer Screening and Surveillance Gina R. Kruse, MD, MS, MPH1,6, Sami M. Khan, BA2, Alan M. Zaslavsky, PhD3, John Z. Ayanian, MD, MPP2,3,4, and Thomas D. Sequist, MD, MPH2,3,5 1
Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; 2Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA; 3Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; 4Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; 5Partners Healthcare System, Boston, MA, USA.
BACKGROUND: Ongoing efforts to increase colorectal cancer (CRC) screening rates have raised concerns that these exams may be overused, thereby subjecting patients to unnecessary risks and wasting healthcare resources. OBJECTIVE: Our aim was to measure overuse of screening and surveillance colonoscopies among average-risk adults, and to identify correlates of overuse. DESIGN, SETTING, AND PARTICIPANTS: Our approach was a retrospective cohort study using electronic health record data for patients 50–65 years old with no personal history of CRC or colorectal adenomas with an incident CRC screening colonoscopy from 2001 to 2010 within a multispecialty physician group practice. MAIN OUTCOME MEASURES: We measured time to next screening or surveillance colonoscopy and predictors of overuse (exam performed more than one year earlier than guideline recommended intervals) of colonoscopies. KEY RESULTS: We identified 1,429 adults who had an incident colonoscopy between 2001 and 2010, and they underwent an additional 871 screening or surveillance colonoscopies during a median follow-up of 6 years. Most follow-up screening colonoscopies (88 %) and many surveillance colonoscopies (49 %) repeated during the study represented overuse. Time to next colonoscopy after incident screening varied by exam findings (no polyp: median 6.9 years, interquartile range [IQR]: 5.1–10.0; hyperplastic polyp: 5.7 years, IQR: 4.9–9.7; low-risk adenoma: 5.1 years, IQR: 3.3– 6.3; high-risk adenoma: 2.9 years, IQR: 2.0–3.4, p
Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; 2Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA; 3Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; 4Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; 5Partners Healthcare System, Boston, MA, USA.
BACKGROUND: Ongoing efforts to increase colorectal cancer (CRC) screening rates have raised concerns that these exams may be overused, thereby subjecting patients to unnecessary risks and wasting healthcare resources. OBJECTIVE: Our aim was to measure overuse of screening and surveillance colonoscopies among average-risk adults, and to identify correlates of overuse. DESIGN, SETTING, AND PARTICIPANTS: Our approach was a retrospective cohort study using electronic health record data for patients 50–65 years old with no personal history of CRC or colorectal adenomas with an incident CRC screening colonoscopy from 2001 to 2010 within a multispecialty physician group practice. MAIN OUTCOME MEASURES: We measured time to next screening or surveillance colonoscopy and predictors of overuse (exam performed more than one year earlier than guideline recommended intervals) of colonoscopies. KEY RESULTS: We identified 1,429 adults who had an incident colonoscopy between 2001 and 2010, and they underwent an additional 871 screening or surveillance colonoscopies during a median follow-up of 6 years. Most follow-up screening colonoscopies (88 %) and many surveillance colonoscopies (49 %) repeated during the study represented overuse. Time to next colonoscopy after incident screening varied by exam findings (no polyp: median 6.9 years, interquartile range [IQR]: 5.1–10.0; hyperplastic polyp: 5.7 years, IQR: 4.9–9.7; low-risk adenoma: 5.1 years, IQR: 3.3– 6.3; high-risk adenoma: 2.9 years, IQR: 2.0–3.4, p
