Screening colonoscopy and fecal occult blood testing practice patterns: a population-based survey of...

Colorectal cancer (CRC) screening guidelines advocate the performance of colonoscopy at 10-year intervals in average-risk patients. Gastroenterologists' acceptance of 10-year intervals between colonoscopies and interim utilization of fecal occult blood testing (FOBT) is largely unknown.

A survey instrument of 15 multiple choice items following brief clinical scenarios involving different CRC screening strategies was sent to 72 practicing gastroenterologists in New Haven County, Connecticut to define screening colonoscopy and FOBT utilization practice patterns.

The overall survey response rate was 75%. Eighty percent of respondents recommend a 10-year screening interval in average-risk patients after normal colonoscopy. Fifty-two percent of respondents recommend annual FOBT beginning 1 to 5 years after a normal screening colonoscopy and, if positive, 59% would evaluate further with colonoscopy and/or esophagogastroduodenoscopy. Repeat colonoscopy in a patient with a family history of colon cancer in a first-degree relative at age 64, was recommended in 3 years by 9%, 5 years (67%), and 7 to 10 years (24%). Repeat colonoscopy in an average-risk patient with a suboptimal bowel preparation was recommended at the next available appointment by 17%, 1 year (20%), 3 years (28%), and in 5 to 7 years (35%).

Most gastroenterologists adhere to colon cancer screening practice guidelines regarding the timing of repeat evaluation in average-risk patients. A range of surveillance intervals was recommended in patients with greater-than-average CRC risk and a suboptimal bowel preparation. A majority of gastroenterologists use interim FOBT and evaluate positive results with additional endoscopic procedures that increase the frequency of surveillance examinations.