The detection rate was defined as the percentage of examinations that found at least one adenoma or adenocarcinoma. There were a total of 264,972 colonoscopies eligible for analysis of interval cancers (cancers diagnosed within 6 months of the index colonoscopy were excluded). They detected 712 interval cancers, 60% of which were proximal, and there was a median interval of 39 months from index colonoscopy to diagnosis of cancer. Adenoma detection rates varied widely among the 136 physicians, from 10% to 60% for male patients and 4% to 46% for female patients. The researchers defined quintiles of adenoma detection rates from 16.6% to 38.9%.They found that the risk of an interval CRC, an advanced stage CRC, and a fatal CRC all declined with increasing adenoma detection rates. For example, compared with the lowest quintile, patients of physicians in the highest quintile had hazard ratios of 0.52 for interval CRC (95% CI, 0.39-0.69) and 0.38 for fatal CRC (0.22 - 0.65).
Mark H. Ebell, MD, MS
University of Georgia
isn't this the same doctor [ebell] who is extolling the virtues of fit on cost alone? [see previous post from marsala a few days ago]. considering the fact that our test has an fit component, and coverage is all but certain, it appears this doctor doesn't know which hand to write with. just sayin'.
Mars, nice find ....i would add with using Cologuard and a subsequent positive result, the colonoscopist will now be more focused on finding the reason why cologuard was positive ... the result will be a colonscopist who is expecting to find something. My guess is it slows the procedure down which leads to a more comprehensive examination. Very good article as it also addresses the proximal and interval CRC's
Ranjo, you make a critical point that has been mostly overlooked. GI's will in fact be very careful with Cologuard positive patients; not only for the legal risk, but also because of the economics: they receive additional fees for every polyp snip performed. The avg. economics of Cologuard-positive patients will exceed colonoscopy-only patients; GI's will pick up on this quickly, and will be very incented to push their patients refusing colonscopy to deliver a Cologuard - it performs 93%+ if not a full 100% of the screening needed, and if they go positive, they are likely a higher revenue patient. Docs with lower detection rates will themselves find some comfort in the help afforded by Cologuard....Bottom line, adoption rates will far exceed the bear case.