The Impact of Compliance to Colonoscopy Screening Guidelines On the Diagnosis of Colon and Rectal Cancer

Rebekah Kim, MD, Joseph T Gallagher, MD, Francisco Itriago, MD, Andrea Ferrara, MD, Jay Macgregor, MD, Kiyanda Baldwin, MD, Paul Williamson, MD, Samuel Dejesus, MD, Renee Mueller, MD. Orlando Health, Colon and Rectal Clinic of Orlando

Introduction: Our purpose is to correlate compliance to the current recommendations for colonoscopy screening to the diagnosis of colon and rectal cancer. Adherence to colonoscopy screening guidelines is one of the best ways to prevent development of colorectal cancer. However, there is limited research on patients with a diagnosis of cancer and prior compliance to colonoscopy screening. We reviewed patients who were diagnosed with colorectal cancer (CRC) and their adherence to the current colon cancer screening guidelines.

Methods : 74 consecutive patients with a diagnosis of cancer were retrospectively reviewed from a colon and rectal surgery practice from 2009 to 2010. All patients underwent surgical resection for colorectal cancer. Analysis of patient’s colonoscopy history was performed examining the following variables: age, indications for colonoscopy, location of tumor, and compliance to colonoscopy screening guidelines according to the American Cancer Society (ACS).

Results : 74 charts were reviewed, 46 males (62%), 28 females(38%). Mean and median ages at the diagnosis of cancer were 63.5 and 65 years (range 28-90). The most common indications for colonoscopy were rectal bleeding(68.9%), weight loss(8.1%) and anemia(10.8%). 19 patients (25.7%) developed colon and rectal cancer despite following screening guidelines. The locations of the cancers are shown in the figure. 13 patients (17.6%) developed CRC prior to age of 50 years of age. Two of these patients had a first degree relative with history of CRC.

17 (23%) patients had prior colonoscopy screening prior to diagnosis of colorectal cancer. Six (8.1%) of these patients were compliant with the current recommendations of the ACS guidelines. The remaining 11 patients had a prolonged time interval between colonoscopies in which CRC developed.

Conclusions : The majority of patients who developed colorectal cancer were diagnosed due to symptoms rather than screening methods. There is a subset of patients that develop colon and rectal cancer despite following the current recommendations of the ACS. The majority of these patients had distal colorectal cancers. Measures to improve effectiveness in colonoscopy screening needs to be further examined within this group of patients.

FIGURE: Tumor Location of Patients Compliant with Colonoscopy Screening