Colonoscopy Screening for Colorectal Cancer: …

Colonoscopy Screening for Colorectal Cancer:

Optimizing Quality

Endoscopist Version Part 1

National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention and Control

Colonoscopy Screening for Colorectal Cancer: Optimizing Quality

Two-part course presented by Dr. David Lieberman:

1. Colorectal cancer and the value of screening / Screening and surveillance guidelines

2. Colonoscopy

Each part includes:

Narrated presentation with slides PDF file of slides for reference

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Links

The slides in this presentation include links to:

External Web sites that contain the abstract or full text, when available, of pertinent articles.

External documents that provide supplemental information. Other slides within this presentation.

To return to the previous slide after viewing the linked slide(s), click GO BACK in the lower right corner.

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Acknowledgments

This presentation was developed by the following group of experts in colorectal cancer screening: Lynn Butterly, MD (gastroenterology) Diane Dwyer, MD (public health, primary care) David Lieberman, MD (gastroenterology) Marion Nadel, PhD (public health, epidemiology) Michael B. Potter, MD (primary care) Paul C. Schroy III, MD, MPH (gastroenterology) Jean Shapiro, PhD (public health, epidemiology) Richard Wender, MD (primary care)

This presentation was developed with support from the Centers for Disease Control and Prevention.

Dr. Lieberman served on the Scientific Advisory Board of Exact Sciences Corporation.

The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the American Cancer Society.

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Introduction

Screening for colorectal cancer (CRC) saves lives.

CRC screening is a complex process that achieves the maximum benefit for the patient when all steps are implemented appropriately.

Problems with screening implementation have been well documented for all screening options.

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What Are Some Implementation Problems?

With Colonoscopy:

? Polyps are missed. ? The cecum is not reached. ? Bowel preparation is sub-optimal. ? The colonoscopy report is missing important elements. ? Recommendations for screening and surveillance intervals are

not consistent with guidelines. ? Endoscopists do not monitor their performance, so they are not

aware when they are not meeting quality standards.

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What Are Some Implementation Problems?

With Fecal Occult Blood Testing (FOBT):

? FOBT not offered as a good option for screening average-risk patients.

? Patient preferences for FOBT not taken into account. ? Use of tests that are no longer recommended. ? Use of in-office tests. ? Abnormal tests not followed up with colonoscopy. ? FOBT tests not repeated annually.

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Goal of This Presentation

To improve screening quality by providing up-to-date guidance on ways to optimize the screening process, with particular emphasis on the areas where current practice often falls short.

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