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Colonoscopies by primary-care doctors safe, study finds

Screening colonoscopies performed by primary-care physicians under strict protocols are as safe and effective as those performed by specialists, according to a new study by researchers from the University of South Carolina’s Arnold School of Public Health.

In the largest published study on the topic in the United States, researchers found performance quality indicators and lesion detection rates in screening colonoscopies by primary-care doctors are comparable to documented rates for experienced gastroenterologists.

Colon cancer is one of the few preventable forms of cancer. A colonoscopy is considered the best test available to identify and prevent colorectal cancer. Primary-care physicians perform a small fraction of colonoscopies -- about 2 percent of those performed nationally in 2002 and 5.7 percent in South Carolina in 2005.

The USC researchers pointed out that the 10,958 colonoscopies by 51 primary-care doctors included in the study were performed under strict protocols to ensure patient safety. The tests were performed at a licensed ambulatory surgery center with specialists (gastroenterologists or GI surgeons) available in case there were technical difficulties in completing the procedure, in removing large polyps or in managing any major complications that can occasionally arise with this procedure.

The study’s results were published online in the journal, Medical Care. Funding for the study came from two grants from the National Cancer Institute along with USC’s Division of Health Sciences and the Center for Colon Cancer Research.

The findings are significant because there are not enough gastroenterologists to perform colonoscopies on everyone eligible to receive one. There is a 50-percent colonoscopy screening gap between those who have the procedure v. those who are eligible to be screened. That is attributed partly to the lack of specialists who perform the test, said Dr. James Hebert, professor of epidemiology and biostatistics in the Arnold School and director of the Cancer Prevention and Control Program at USC.

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