Original StudyColorectal Cancer Initial Diagnosis: Screening Colonoscopy, Diagnostic Colonoscopy, or Emergent Surgery, and Tumor Stage and Size at Initial Presentation
Introduction
Colorectal cancer is the third most common type of cancer and cause of cancer-related death in the United States.1 An estimated 136,830 individuals were newly diagnosed with colorectal cancer and 50,319 people died as a result of the disease in the United States in 2014.1 Colorectal cancer screening reduces mortality by identifying cancers at an earlier and more treatable stage and by identifying and removing precancerous adenomatous polyps.2, 3, 4, 5, 6, 7, 8 However, only approximately 34% to 59% of Americans for whom screening is recommended undergo recommended colorectal cancer screening.9, 10, 11 The United States Preventive Services Task Force currently recommends screening for colorectal cancer using colonoscopy, sigmoidoscopy, or fecal occult blood testing beginning at age 50 years and continuing until age 75 years.12
Approximately 15% of colorectal cancers present as a surgical emergency in the United States.13 To our knowledge, no studies have reported on what percentage of colorectal malignancies is diagnosed at the time of screening versus diagnostic colonoscopy. Accurately extracting such information from claims databases is challenging.14, 15, 16 For example, a colonoscopy that begins as a screening colonoscopy in an asymptomatic individual is typically coded as a diagnostic colonoscopy if a biopsy is performed or a polyp removed.16
The purpose of this investigation was to determine through detailed chart review how patients who presented to our institution between 2011 and 2014 were diagnosed with colorectal cancer (screening colonoscopy, diagnostic colonoscopy, or emergent surgery) and tumor stage and size at the time of diagnosis.
Section snippets
Patients and Methods
Institutional review board approval was obtained, and a waiver of informed consent was granted for this Health Insurance Portability and Accountability Act-compliant study.
The (X [institution name blinded during the review process]) electronic data warehouse was searched for patient encounters in which the Current Procedural Terminology codes for new patient visit (99201, 99202, 99203, 99204, 99205) and the International Classification of Diseases, 9th edition codes for colorectal cancer
Results
A data warehouse search yielded 527 patients. Based on chart review, 35 individuals (6.6%) were coded incorrectly because they did not have a diagnosis of colorectal cancer, and these individuals were excluded from the analysis. The remaining 492 individuals were our study population.
Discussion
Interestingly, only 10.7% of colorectal cancers in our series were diagnosed at the time of screening colonoscopy. For individuals 50 to 75 years of age, 14% of cancers were diagnosed at the time of screening colonoscopy. Most individuals treated for colorectal cancer at our institution sought medical attention on the basis of a symptom. At least 31% of patients diagnosed with cancer at the time of screening colonoscopy, 19% of patients diagnosed with cancer at the time of diagnostic
Conclusion
Nearly 90% of colorectal cancer patients were diagnosed after development of symptoms and had more advanced disease than asymptomatic patients whose cancers were detected with screening. Colorectal cancer outcomes will be improved by improving rates of colorectal cancer screening.
Disclosure
The authors have stated that they have no conflicts of interest.
References (23)
- et al.
Comparison of compliance for colorectal cancer screening and surveillance by colonoscopy based on risk
Genet Med
(2011) - et al.
Adherence with colorectal cancer screening guidelines: a review
Prev Med
(2004) - et al.
Tumor size predicts long-term survival in colon cancer: an analysis of the National Cancer Data Base
Am J Surg
(2015) - et al.
Colorectal cancer statistics, 2014
CA Cancer J Clin
(2014) Screening for colorectal cancer: U.S. Preventive Services Task Force Recommendation Statement
Ann Intern Med
(2008)- et al.
Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: a systematic review and meta-analysis of randomized controlled trials and observational studies
BMJ
(2014) - et al.
The colorectal adenoma-carcinoma sequence
Br J Surg
(2002) - et al.
Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup
N Engl J Med
(1993) - et al.
Long-term risk of colorectal cancer after excision of rectosigmoid adenomas
N Engl J Med
(1992) - et al.
Colonoscopic polypectomy and long-term prevention of colorectal cancer deaths
N Engl J Med
(2012)