Douglas K. Rex, MD reviewing Baxter NN et al. J Clin Oncol 2012 Jul 20.
large case-control study found a 30% reduction in risk for death from colorectal cancer when colonoscopy was performed by
a gastroenterologist versus another specialist.
Several studies have demonstrated a higher risk for colorectal
cancer (CRC) after colonoscopies performed by general surgeons or primary care physicians versus gastroenterologists (JW Gastroenterol Mar 26 2010). Now, investigators have examined the effect of colonoscopy on mortality from CRC and whether it varied by colonoscopist
In this case-control study, researchers used Surveillance, Epidemiology, and End Results (SEER) Medicare
data to identify 9458 cases - patients who died from CRC and received a first diagnosis of CRC between the ages of 70 and
89 while enrolled in Medicare but not in managed care - and 27,641 controls who did not have CRC.
associated with a 60% risk reduction for CRC overall, with a slightly lower risk reduction for women (56%) and lower risk
reduction for patients aged >75 versus 70 to 75 years (55% vs. 72%). As observed in numerous studies, risk reduction was
greater in the distal colon compared with the proximal colon (76% vs. 42%). Colonoscopy performed by a gastroenterologist
was associated with a 65% reduction in risk for CRC mortality, compared with 57% when performed by a primary care provider
and 45% by a surgeon (defined as general surgeon, colorectal surgeon, abdominal surgeon, or surgical oncologist). The odds
ratio for death from CRC when colonoscopy was performed by a gastroenterologist versus any other specialist was 0.71 (95%
confidence interval, 0.62-0.81).