Study Finds Increase in Colonoscopy Rates Has Lead to Overuse
A retrospective study led by researchers at Brigham and Women's Hospital has found an overuse of colonoscopies for colorectal cancer screening and surveillance. The study demonstrated that endoscopists commonly recommended shorter follow-up intervals than established guidelines support, and these recommendations were strongly correlated with subsequent colonoscopy overuse. The findings were reported by Kruse et al in the Journal of General Internal Medicine.
"Our study shows that a high percentage of follow-up colonoscopies are being performed too early, resulting in use of scarce health-care resources with potentially limited clinical benefit," said senior study author Thomas D. Sequist MD, MPH, of Division of General Medicine and Primary Care at Brigham and Women’s Hospital.
Study Details
In the retrospective cohort study, researchers combed electronic health record data of primary care patients at Harvard Vanguard Medical Associates, a multispecialty physician group practice in Massachusetts. The study included 1,429 patients aged 50 to 65 years who underwent their first screening colonoscopy between 2001 and 2010 and underwent an additional 871 follow-up colonoscopies during a median follow-up of 6 years.
According to the researchers, 88% of follow-up screening colonoscopies and 49% of surveillance colonoscopies repeated during the study represented overuse—meaning they were performed more than 1 year early, and often times over 3 to 4 years earlier than is recommended by national guidelines. At the same time, one-quarter of study patients identified as higher risk based on initial colonoscopy findings failed to receive follow-up colonoscopy within the recommended 3- or 5-year time period.
Endoscopist Recommendations May Lead to Overuse
Early colonoscopy was recommended by endoscopists following more than one-half of the initial colonoscopies. Colonoscopy overuse was strongly associated with these early follow-up recommendations by endoscopists; patients were up to 13 times more likely to undergo an early colonoscopy when their endoscopist recommended such follow-up.
"Previous research has shown that most endoscopists do not consistently agree with the follow-up intervals recommended in national guidelines and report preferences for shorter screening and surveillance intervals," said Dr. Sequist. "Examining practice variation and establishing locally endorsed standards among endoscopists may be a way to target interventions to reduce overuse."
He added, "There are likely multiple drivers of recommendations for early colonoscopy, including disagreement with current guidelines, fear of poor patient outcomes or malpractice, or misaligned financial incentives."
"The overused colonoscopies on the patients in this study alone represent a potential excess of over $1 million in health-care spending-resources that might benefit those who are overdue for colon cancer screening," said lead study author Gina Kruse, MD, of Massachusetts General Hospital.
Dr. Kruse is the corresponding author for the Journal of General Internal Medicine article.
This research was supported by the National Cancer Institute, Health Resources and Services Administration, and Ryoichi Sasakawa Fellowship Fund. The study authors reported no potential conflicts of interest.
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