Special article
Current capacity for endoscopic colorectal cancer screening in the United States: data from the National Cancer Institute Survey of Colorectal Cancer Screening Practices

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Abstract

Purpose

There is a national goal in the United States to increase the level of colorectal cancer screening, but there is currently little information on resources for the delivery of endoscopic screening and follow-up diagnostic and surveillance procedures. The purpose of this study was to provide nationally representative data on endoscopic resources at the provider level.

Methods

A nationally representative survey of primary care physicians, general surgeons, and gastroenterologists that was conducted during 1999 to 2000 provided data from survey responses by 1235 primary care physicians, 349 gastroenterologists, and 316 general surgeons.

Results

We estimated that 65% of all sigmoidoscopy procedures were performed by primary care physicians, 25% by gastroenterologists, and 10% by general surgeons. Only 30% of all primary care physicians performed any procedures, and average volume among those who did was relatively low (seven per month). Gastroenterologists performed two thirds of all colonoscopy procedures, with most of the remainder performed by general surgeons.

Conclusion

There is potential to increase the capacity to perform screening sigmoidoscopy procedures through primary care delivery. However, without careful consideration of organizational factors, this could result in increased cost and quality control problems. Increasing the capacity for screening colonoscopy is feasible, but will require attention to other problems, such as avoiding overfrequent (e.g., annual or biennial) procedures in low-risk patients.

Section snippets

Survey

We used data from the primary care and gastroenterology/general surgery components of the Survey of Colorectal Cancer Screening Practices, collected between November 1999 and April 2000. We focused on factors related to endoscopy procedures because double-contrast barium enema is used rarely for screening or diagnostic follow-up in current practice 10, 11. The survey samples of 1630 primary care physicians, 467 gastroenterologists, and 467 general surgeons were obtained from the American

Results

We obtained 1235 responses to the primary care survey, a response rate of 72%, and 665 to the specialty survey (349 gastroenterologists, 316 general surgeons), a response rate of 83%. Specialty physicians were more likely than primary care physicians to be male and to be white and had fewer patients covered by managed care contracts (Table 1). Gastroenterologists tended to be younger and board certified, to have a medical school affiliation, and to be located in a metropolitan area. General

Discussion

We used nationally representative data about the activities of the main physician specialties that perform colorectal cancer screening procedures to generate estimates of the total number of endoscopic colorectal procedures performed in the United States. Although we did not validate these self-reported data against administrative or clinical records, our estimates are remarkably consistent with those generated from other sources. For example, Rex and Lieberman reported that about 4.4 million

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