Colorectal screening after polypectomy: a national survey study of primary care physicians

Ann Intern Med. 2006 Nov 7;145(9):654-9. doi: 10.7326/0003-4819-145-9-200611070-00007.


Background: Recommendations by primary care physicians for colorectal screening after polypectomy will influence rates of colonoscopy in open-access systems that do not require consultation by a gastroenterologist before colonoscopy.

Objective: To determine the surveillance recommendations of primary care physicians after polypectomy and compare them with recommendations from the U.S. Multisociety Task Force on Colorectal Cancer.

Design: Cross-sectional study of physicians.

Setting: United States.

Participants: A random sample of 500 physicians from the American College of Physicians and 500 physicians from the American Academy of Family Physicians, obtained by using a mail survey.

Measurements: Physicians were asked when they would recommend repeated colonoscopy for a hypothetical 55-year-old man with no family history of colorectal cancer after the following 6 results on colonoscopy: hyperplastic polyp, one 6-mm tubular adenoma, two 6-mm tubular adenomas, one 12-mm tubulovillous adenoma, one 12-mm tubular adenoma with focal high-grade dysplasia, and no polyp but a previous tubular adenoma.

Results: The overall response rate was 57% (568 physicians). Of the respondents, 48% were internists and 52% were family practitioners. Sixty-one percent of respondents would survey a hyperplastic polyp in 5 years or less, 71% would survey a single tubular adenoma in 3 years or less, and 80% would survey 2 tubular adenomas in 3 years or less.

Limitations: The results are based on physicians' self-reported practices from clinical vignettes and may not match actual practice.

Conclusion: Primary care physicians recommend postpolypectomy colonoscopic surveillance more frequently than is recommended by practice guidelines, especially if the colonoscopy showed a hyperplastic polyp or a single small adenoma.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenoma, Villous / diagnosis
  • Adenoma, Villous / surgery
  • Adenomatous Polyps / diagnosis
  • Adenomatous Polyps / surgery
  • Colonic Polyps / diagnosis
  • Colonic Polyps / pathology
  • Colonic Polyps / surgery*
  • Colonoscopy / statistics & numerical data*
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Guideline Adherence
  • Humans
  • Hyperplasia / diagnosis
  • Hyperplasia / surgery
  • Male
  • Middle Aged
  • Physicians, Family*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'*
  • Risk Factors
  • Sigmoid Neoplasms / diagnosis
  • Sigmoid Neoplasms / pathology
  • Sigmoid Neoplasms / surgery*
  • Surveys and Questionnaires
  • Time Factors
  • United States