- Email: [email protected]
Moving beyond colon cancer awareness
EDITOR’S NOTE
Moving beyond colon cancer awareness March 2011 marks the 12th annual National Colorectal Cancer (CRC) Awareness Month. Numerous efforts are made nationwide to increase patient knowledge regarding CRC, to increase screening efforts, and to promote lifestyle changes to decrease risk. As gastroenterologists and practicing endoscopists, much of our daily efforts revolve around screening, diagnosis, and treatment for this malignancy. Therefore, GIE is devoting this issue to topics germane to these endeavors. We invited researchers from the Centers for Disease Control and Prevention (CDC) to submit an article describing their work in extending screening for CRC prevention. In 2009, they began a public health initiative—the Colorectal Cancer Control Program, which includes 2 components: (1) a screening provision, supporting clinical service delivery for low-income, underinsured persons and (2) a screening promotion, involving activities to encourage broad, population-level screening. The article describes in detail their efforts to increase screening adherence to 80% of the population. There has been a plethora of articles recently assessing metrics for improving the quality of screening colonoscopy. One of these surrogate measures is adenoma detection rates (ADRs). We have several articles in the current issue that describe potential methods to improve the ADR. This includes using a device to look behind colonic folds (the retroscope) as well as simply changing patient position during the procedure (East et al). Much has been made about the decreasing yield of colonoscopy as the day progresses in the endoscopy lab because of operator fatigue and/or suboptimal PM preps. An article from the Mayo Clinic suggests that having endoscopists perform endoscopic procedures in 3-hour blocks could eliminate the fatigue factor. There are 2 articles (Francis et al, Williams et al) in this issue
Copyright © 2011 by the American Society for Gastrointestinal Endoscopy 0016-5107/$36.00 doi:10.1016/j.gie.2011.01.028
428 GASTROINTESTINAL ENDOSCOPY Volume 73, No. 3 : 2011
that evaluate using polyp detection rate (PDR) instead of the ADR because measuring the ADR requires pathology follow-up and could be more cumbersome to calculate. Not surprisingly, there is a correlation, and at some point this measure could be more commonly used. Ultimately, we may be getting further and further away from measures that truly matter such as minimizing interval CRC (between colon examinations) and CRC-related mortality reductions. Speaking of that, Stock et al discuss the fraction of CRC-related mortality decreases that have been estimated by the use of colonoscopy, as high as 19%, whereas the proportion of deaths attributable to nonuse of colonoscopy ranges between 28% and 44%; highlighting colonoscopy can be an effective tool to decrease mortality rates, but we still have a long way to go. This issue also has 2 articles discussing the approach to incomplete colon examinations— using single-balloon colonoscopy or spiral-assisted examinations (Keswani et al, Schembre et al). Overall, we have 17 original articles pertaining to aspects regarding colonoscopy and/or CRC. We also have Drs. Sonnenberg and Lieberman debate the “quality issue.” Although many, if not all, of us would equate being “for quality” like being “for mom and apple pie,” there remain issues of avoiding unnecessary costs and efforts as well as the necessity of outcome improvements beyond simply measuring withdrawal times and detection rates. Finally, we are reintroducing a series that last ran about 5 years ago. Our biostatistics series is intended to be reader, author, and endoscopist friendly so that each of you will get more out of reading each issue of GIE, and other journals you peruse—after GIE. We hope that you enjoy and learn from this issue, and of course we welcome your feedback, as always. Glenn Eisen, MD, MPH Editor-in-Chief
www.giejournal.org
Moving beyond colon cancer awareness March 2011 marks the 12th annual National Colorectal Cancer (CRC) Awareness Month. Numerous efforts are made nationwide to increase patient knowledge regarding CRC, to increase screening efforts, and to promote lifestyle changes to decrease risk. As gastroenterologists and practicing endoscopists, much of our daily efforts revolve around screening, diagnosis, and treatment for this malignancy. Therefore, GIE is devoting this issue to topics germane to these endeavors. We invited researchers from the Centers for Disease Control and Prevention (CDC) to submit an article describing their work in extending screening for CRC prevention. In 2009, they began a public health initiative—the Colorectal Cancer Control Program, which includes 2 components: (1) a screening provision, supporting clinical service delivery for low-income, underinsured persons and (2) a screening promotion, involving activities to encourage broad, population-level screening. The article describes in detail their efforts to increase screening adherence to 80% of the population. There has been a plethora of articles recently assessing metrics for improving the quality of screening colonoscopy. One of these surrogate measures is adenoma detection rates (ADRs). We have several articles in the current issue that describe potential methods to improve the ADR. This includes using a device to look behind colonic folds (the retroscope) as well as simply changing patient position during the procedure (East et al). Much has been made about the decreasing yield of colonoscopy as the day progresses in the endoscopy lab because of operator fatigue and/or suboptimal PM preps. An article from the Mayo Clinic suggests that having endoscopists perform endoscopic procedures in 3-hour blocks could eliminate the fatigue factor. There are 2 articles (Francis et al, Williams et al) in this issue
Copyright © 2011 by the American Society for Gastrointestinal Endoscopy 0016-5107/$36.00 doi:10.1016/j.gie.2011.01.028
428 GASTROINTESTINAL ENDOSCOPY Volume 73, No. 3 : 2011
that evaluate using polyp detection rate (PDR) instead of the ADR because measuring the ADR requires pathology follow-up and could be more cumbersome to calculate. Not surprisingly, there is a correlation, and at some point this measure could be more commonly used. Ultimately, we may be getting further and further away from measures that truly matter such as minimizing interval CRC (between colon examinations) and CRC-related mortality reductions. Speaking of that, Stock et al discuss the fraction of CRC-related mortality decreases that have been estimated by the use of colonoscopy, as high as 19%, whereas the proportion of deaths attributable to nonuse of colonoscopy ranges between 28% and 44%; highlighting colonoscopy can be an effective tool to decrease mortality rates, but we still have a long way to go. This issue also has 2 articles discussing the approach to incomplete colon examinations— using single-balloon colonoscopy or spiral-assisted examinations (Keswani et al, Schembre et al). Overall, we have 17 original articles pertaining to aspects regarding colonoscopy and/or CRC. We also have Drs. Sonnenberg and Lieberman debate the “quality issue.” Although many, if not all, of us would equate being “for quality” like being “for mom and apple pie,” there remain issues of avoiding unnecessary costs and efforts as well as the necessity of outcome improvements beyond simply measuring withdrawal times and detection rates. Finally, we are reintroducing a series that last ran about 5 years ago. Our biostatistics series is intended to be reader, author, and endoscopist friendly so that each of you will get more out of reading each issue of GIE, and other journals you peruse—after GIE. We hope that you enjoy and learn from this issue, and of course we welcome your feedback, as always. Glenn Eisen, MD, MPH Editor-in-Chief
www.giejournal.org