What is your adenoma detection rate?
That's the critical question patients should ask their gastroenterologist before undergoing a colonoscopy, according to new research.
Your risk of developing colon cancer may depend partly on having a doctor who often spots precancerous growths during patients' colonoscopy screenings, a new study suggests.
Colonoscopy is considered the gold standard for colon cancer screening. It's effective because it can detect not only tumors, but also precancerous polyps – which can be removed then and there.
Doctors vary in how often they pick up precancerous polyps, or adenomas. But it hasn't been clear whether a doctor's adenoma detection rate is actually related to patients' risk of developing colon cancer. New findings in the New England Journal of Medicine point to an association.
Looking at records for more than 224,000 California patients, researchers found that when doctors had a higher adenoma detection rate, their patients had a lower risk of developing or dying from colon cancer. For every 1 percent increase in a doctor's adenoma detection rate, patients' risk of developing cancer over the next decade dipped by 3 percent.
Presumably, that's because precancerous growths are being removed and never have a chance to progress, said Douglas Corley, M.D., a gastroenterologist at Kaiser Permanente in Oakland, Calif., who led the study.
Dr. Corley called the findings a "first step" toward using doctors' adenoma detection rates as a quality-of-care measure that's reported to Medicare and made widely available to the public. Until then, patients can ask their doctors what their detection rate is, Dr. Corley said.
A gastroenterologist not involved in the study agreed.
"Many (doctors) make quality measures available to their patients," said Lawrence Kim, M.D., who serves as the community private practice councilor for the American Gastroenterological Association.
That information may be in the written materials your doctor gives you or on the practice's website, Dr. Kim said.
And what is a "good" adenoma detection rate? Some benchmarks have been proposed, Dr. Kim noted: a 25 percent rate or higher for men, and 15 percent or higher for women. (Adenomas are more common in men.)
In the new research, adenoma detection rates varied widely – from a low of 7 percent to more than 52 percent.
There are several potential reasons that doctors' adenoma detection rates would range widely, Dr. Corley said. One, he noted, is "just the random variation in the patients doctors see."
If one doctor has more female patients, or younger patients, than another doctor, it makes sense that their adenoma detection rates would be lower, Dr. Corley explained.
But skills count, too. "There may be differences in how well doctors are able to see and remove adenomas," Dr. Corley said. His team is now studying whether better training helps improve adenoma detection rates among doctors with lower numbers.
Colonoscopies should be done every 10 years beginning at age 50 through age 75, when screening then becomes an individual decision to be made with your doctor, according to the U.S. Centers for Disease Control and Prevention.
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