Quality Matters in Preventing Colon Cancer

March is Colorectal Cancer Awareness Month. This gives me an opportunity to discuss this very important disease with my patients.  Colorectal cancer is the second leading cause of cancer death in the United States when men and women are combined together. It is the third leading cause of cancer death in men behind lung cancer and prostate cancer. In women, it is the third leading killer behind lung cancer and breast cancer.

Over the past 10 years, there has been a decline in the incidence of colorectal cancer attributed to the detection and removal of precancerous polyps (adenomas) as a result of increased colorectal cancer screening. This has resulted in a significant decline in the death rates from colorectal cancer over this same time period.

To summarize: Screening colonoscopy significantly reduces the chance of developing colorectal cancer.

Despite this, statistics show that only 60% of individuals of screening age (age greater than 50) actually undergo screening colonoscopy. That is, 4 out 10 people do not undergo screening colonoscopy. This is a disappointing statistic! I believe individuals avoid this life saving procedure because they fear the “unknown.”

These are common misconceptions about colonoscopies:

  • The procedure is going to hurt.
  • You will be awake during the procedure.
  • The bowel preparation is torture.

All these ideas are completely false. Patients are completely asleep during the procedure, there is no pain involved, and the bowel preparation is manageable.

Finally, a colonoscopy is only as good as the physician performing the examination. One the most important measures of a “quality” colonoscopy examination is the ability to detect and remove precancerous polyps (adenomas) from the colon. The rate at which a physician discovers and removes these polyps is called the adenoma detection rate (ADR). This rate of detection is determined by how meticulous the physician is with the examination and the amount of time spent examining the colon. Physicians with low adenoma detection rates have a higher chance of their patients developing colon cancer in future years.

We measure this adenoma detection rate in our practice as a way of monitoring our quality. The performance targets recommended by the American Society for Gastrointestinal Endoscopy (ASGE) are > 20% for women and > 30% for men. My adenoma detection rate consistently exceeds the recommended standards.   This equates a to superior examination for my patients.

Don’t you want a physician performing your colonoscopy who will provide a quality examination to reduce your chance of developing colorectal cancer?   I believe quality matters.


Richard Warneke, M.D.