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      Resident Knowledge of Colorectal Cancer Screening Assessed by Web-Based Survey

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          Abstract

          Background

          To evaluate resident knowledge of colorectal cancer (CRC) screening guidelines and to define areas requiring attention.

          Methods

          A survey was created using three published guidelines for CRC screening. Program directors for internal medicine residency programs were contacted within the metro New York City area to have their residents participate.

          Results

          Five programs participated, and 115 responses were recorded. For the appropriate testing and interval to screen for CRC, 61/115 residents identified flexible sigmoidoscopy every 5 years, 108/115 identified colonoscopy every 10 years, 16/115 identified double contrast barium enema (DCBE) every 5 years and only 12/115 thought CT-colography every 5 years was appropriate. Only 40/115 respondents appropriately identified fecal occult blood testing (FOBT) administered in the patient’s home annually, while fecal immunohistochemical testing (FIT) annually at home was identified by 8/115 residents.

          Conclusion

          While most residents seem knowledgeable regarding CRC screening with colonoscopy, many deficiencies remain. FOBT for screening purposes remains undervalued, and confusion about administering the test persists. The distinction between screening and prevention needs further reinforcement.

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          Most cited references21

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          Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.

          In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that primarily is effective at early cancer detection and a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening.
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            Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement.

            (2008)
            Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for colorectal cancer. To update its recommendation, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review on 4 selected questions relating to test characteristics and benefits and harms of screening technologies, and 2) a decision analytic modeling analysis using population modeling techniques to compare the expected health outcomes and resource requirements of available screening modalities when used in a programmatic way over time. The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary. (A recommendation). The USPSTF recommends against routine screening for colorectal cancer in adults 76 to 85 years of age. There may be considerations that support colorectal cancer screening in an individual patient. (C recommendation). The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years. (D recommendation). The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer. (I statement).
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              American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected].

              This document is the first update of the American College of Gastroenterology (ACG) colorectal cancer (CRC) screening recommendations since 2000. The CRC screening tests are now grouped into cancer prevention tests and cancer detection tests. Colonoscopy every 10 years, beginning at age 50, remains the preferred CRC screening strategy. It is recognized that colonoscopy is not available in every clinical setting because of economic limitations. It is also realized that not all eligible persons are willing to undergo colonoscopy for screening purposes. In these cases, patients should be offered an alternative CRC prevention test (flexible sigmoidoscopy every 5-10 years, or a computed tomography (CT) colonography every 5 years) or a cancer detection test (fecal immunochemical test for blood, FIT).
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                Author and article information

                Journal
                J Clin Med Res
                J Clin Med Res
                Elmer Press
                Journal of Clinical Medicine Research
                Elmer Press
                1918-3003
                1918-3011
                April 2014
                06 February 2014
                : 6
                : 2
                : 120-126
                Affiliations
                [a ]NSLIJ - Western Suffolk Gastroenterology, Bay Shore, NY, USA
                [b ]Hofstra - Northshore LIJ School of Medicine, Hempstead, NY, USA
                [c ]Department of Internal Medicine, Division of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
                [d ]Department of Internal Medicine, Division of Gastroenterology, Northshore Long Island Jewish Medical Center, Manhasset, NY, USA
                [e ]Feinstein Institute for Medical Research, Manhasset, NY, USA
                Author notes
                [f ]Corresponding author: Stuart Akerman, 375 East Main Street, Suite 21, Bay Shore, NY 11706, USA. Email: sakerman@ 123456nshs.edu
                Article
                10.14740/jocmr1610w
                3935520
                24578753
                16322aab-117a-4d72-9cbd-36d9718149c9
                Copyright 2014, Akerman et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 September 2013
                Categories
                Original Article

                Medicine
                resident education,colorectal cancer,preventive medicine
                Medicine
                resident education, colorectal cancer, preventive medicine

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