Korean J Gastroenterol.  2012 Jul;60(1):26-35. 10.4166/kjg.2012.60.1.26.

A Korean National Survey for Colorectal Cancer Screening and Polyp Diagnosis Methods Using Web-based Survey

• Kim SE
• Hong SP
• Kim HS
• Lee BI
• Kim SH
• Hong SN
• Yang DH
• Lee SH
• Shin SJ
• Park DI
• Kim YH
• Yang SK
• Kim HJ
• Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management

• KMID: 1718463
• DOI: http://doi.org/10.4166/kjg.2012.60.1.26

Abstract

BACKGROUND/AIMS
There is a paucity of national guideline for colorectal cancer screening and polyp diagnosis in Korea. Thus, we investigated the present state of colorectal cancer screening and polyp diagnosis methods using web-based survey to use as reference data for developing a guideline.
METHODS
A multiple choice questionnaires of screening recommendations was sent via e-mail to members of the Korean Association for the Study of Intestinal Diseases and primary care physicians who participated in the national colonoscopy surveillance program. Among 425 colonoscopists, a total 263 colonoscopists replied (response rate, 61.9%).
RESULTS
The most commonly recommended starting age for colorectal cancer screening and polyp diagnosis was 50 years old in the average risk group, and 40 years old in groups who had a family history of colon cancer (64.3% and 65.0% respectively). Surgeons had a tendency to recommend screening in younger people than internist do. Ninety-eight percent of physicians recommended screening colonoscopy to asymptomatic, average-risk patients as a first choice. Only 2% of physicians chose sigmoidoscopy as a screening tool. When the initial colonoscopy showed a negative finding, over 60% of internists repeated the exam 5 years later, whereas 62% of surgeons did so within 3 years.
CONCLUSIONS
The starting age of colorectal cancer screening and the interval of the colorectal polyp examination are not uniform in various medical environments, and there is a discrepancy between the practical recommendations and western guidelines. Thus, a new evidence-based national practice guideline for colorectal cancer screening and polyp diagnosis should be developed.

Keyword

Colorectal cancer; Colorectal neoplasms; Screening; Diagnosis; Colonoscopy

MeSH Terms

Adult
Age Factors
Asian Continental Ancestry Group
Colonic Polyps/*diagnosis/surgery
Colonoscopy
Colorectal Neoplasms/*diagnosis
Data Collection
Early Detection of Cancer
Female
Health Care Surveys
Humans
*Internet
Male
Middle Aged
Physician's Practice Patterns
Questionnaires
Republic of Korea

Figure

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  Fig. 1 Questionnaire about physician's perceptions and recommendations for colorectal cancer/polyp screening.

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  Fig. 2 The most influential guideline in practice. KSCP/NCC guideline was a most referenced guideline by physicians in this survey. The next influential guideline was ASGE guideline. KSCP, Korean Society of Coloproctology; NCC, National Cancer Center; ASGE, American Society of Gastrointestinal Endoscopy; USMSTF, US Multi-Society Task Force; ACS, American Cancer Society; ACG, American College of Gastroenterology; BSG, British Society of Gastroenterology; EPAGE, European Panel on the Appropriateness of Gastrointestinal Endoscopy.

• 

  Fig. 3 Physician's perceptions of test performance for colorectal polyp diagnosis (n=263). Eighty-four percent of physicians recognized colonoscopy was a very effective screening tool for colorectal cancer/polyp, while FOBT was recognized as an ineffective screening tool by 57% of physicians. DCBE, double contrast barium enema; FOBT, fecal occult blood test.

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  Fig. 4 Physician's modality-specific recommendations for colorectal polyp screening (n=263). Multiple choices were allowed. Ninety-eight percent of physicians recommend screening colonoscopy to asymptomatic, average-risk patients as a first choice. Only 2% of physicians choose sigmoidoscopy as a screening tool. CFS, colonoscopy; CTC, CT colonography; FOBT, fecal occult blood test; Sig, Sigmoidoscoy; DCBE, double contrast barium enema.

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  Fig. 5 Physicians' action for a detected polyp at screening colonoscopy. For polyps smaller than 0.5 cm, 84% of physicians removed them immediately after the detection using biopsy forcep. For polyps larger than 1.0 cm, 54.4% of physicians removed them with one-stage polypectomy, 38.4% with two-stage polypectomy.

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