Clinical Question

What proportion of screening colonoscopies for cancer are not performed according to guideline parameters?

Bottom Line

About 17% to 25.7% of screening colonoscopies are performed too frequently or in patients who are too young or too old. In the United States, this rate translates into approximately 1 million colonoscopies performed each year outside of the parameters set by guidelines. Screening via colonoscopy for colon cancer has never been shown to reduce overall mortality. (Level of Evidence = 1a−)

Synopsis

The researchers searched two databases for English-language studies of screening colonoscopies for average-risk patients, identifying six studies with 242,756 screening colonoscopies. The studies defined colonoscopy overuse according to criteria from the U.S. Preventive Services Task Force and the U.S. Multi-Society Task Force on Colorectal Cancer; that is, colonoscopy conducted in patients younger or older than the age range specified in national guidelines or at shorter intervals than recommended. The researchers followed PRISMA guidelines: two researchers selected articles for inclusion and two researchers independently abstracted data. These were all database studies. The studies reported one in four to one in six (17% to 25.7%) colonoscopies to be out of compliance with national guidelines.

This POEM aligns with the Canadian Association of General Surgeons' Choosing Wisely Canada recommendation: avoid colorectal cancer screening in asymptomatic patients with a life expectancy of less than 10 years and with no personal or family history of colorectal neoplasia.

Study design: Systematic review

Funding source: Foundation

Setting: Various (meta-analysis)

Reference: Fraiman J, Brownlee S, Stoto MA, et al. An estimate of the US rate of overuse of screening colonoscopy: a systematic review. J Gen Intern Med. 2022:1-9. Published online February 25, 2022.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.