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Kim, Hong, Kim, Lee, Kim, Hong, Yang, Lee, Shin, Park, Kim, Yang, Kim, and Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management: A Korean National Survey for Colorectal Cancer Screening and Polyp Diagnosis Methods Using Web-based Survey
Original Article
Alimentary Tract
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 60(1): 26-35.

Published online: 20 July 2012

DOI: https://doi.org/10.4166/kjg.2012.60.1.26

A Korean National Survey for Colorectal Cancer Screening and Polyp Diagnosis Methods Using Web-based Survey

Seong-Eun Kim1, Sung Pil Hong2, Hyun-Soo Kim3, Bo In Lee4, Se Hyung Kim5, Sung Noh Hong6, Dong-Hoon Yang7, Suck Ho Lee8, Sung Jae Shin9, Dong Il Park10, Young-Ho Kim11, Suk-Kyun Yang7, Hyo Jong Kim12; Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management

1Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

3Department of Internal Medicine, Yonsei University Wonju College of Medicine, Seoul, Korea.

4Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea.

5Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

6Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.

7Department of Gastroenterology, Ulsan University College of Medicine, Seoul, Korea.

8Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Seoul, Korea.

9Department of Gastroenterology, Ajou University School of Medicine, Seoul, Korea.

10Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

11Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

12Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea.

Correspondence to: Hyun-Soo Kim, Digestive Disease Center, Department of Internal Medicine, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju 220-701, Korea. Tel: +82-33-741-1229, Fax: +82-33-741-1228, hyskim@yonsei.ac.kr

Received 4 October 2011       Revised 26 December 2011       Accepted 1 February 2012

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

There is a paucity of national guideline for colorectal cancer screening and polyp diagnosis in Korea. Thus, we investigated the present state of colorectal cancer screening and polyp diagnosis methods using web-based survey to use as reference data for developing a guideline.

Methods

A multiple choice questionnaires of screening recommendations was sent via e-mail to members of the Korean Association for the Study of Intestinal Diseases and primary care physicians who participated in the national colonoscopy surveillance program. Among 425 colonoscopists, a total 263 colonoscopists replied (response rate, 61.9%).

Results

The most commonly recommended starting age for colorectal cancer screening and polyp diagnosis was 50 years old in the average risk group, and 40 years old in groups who had a family history of colon cancer (64.3% and 65.0% respectively). Surgeons had a tendency to recommend screening in younger people than internist do. Ninety-eight percent of physicians recommended screening colonoscopy to asymptomatic, average-risk patients as a first choice. Only 2% of physicians chose sigmoidoscopy as a screening tool. When the initial colonoscopy showed a negative finding, over 60% of internists repeated the exam 5 years later, whereas 62% of surgeons did so within 3 years.

Conclusions

The starting age of colorectal cancer screening and the interval of the colorectal polyp examination are not uniform in various medical environments, and there is a discrepancy between the practical recommendations and western guidelines. Thus, a new evidence-based national practice guideline for colorectal cancer screening and polyp diagnosis should be developed.

Keywords: Colorectal cancer, Colorectal neoplasms, Screening, Diagnosis, Colonoscopy

Figures and Tables

Fig. 1
Questionnaire about physician's perceptions and recommendations for colorectal cancer/polyp screening.
kjg-60-26-g001
Fig. 2
The most influential guideline in practice. KSCP/NCC guideline was a most referenced guideline by physicians in this survey. The next influential guideline was ASGE guideline.
KSCP, Korean Society of Coloproctology; NCC, National Cancer Center; ASGE, American Society of Gastrointestinal Endoscopy; USMSTF, US Multi-Society Task Force; ACS, American Cancer Society; ACG, American College of Gastroenterology; BSG, British Society of Gastroenterology; EPAGE, European Panel on the Appropriateness of Gastrointestinal Endoscopy.
kjg-60-26-g002
Fig. 3
Physician's perceptions of test performance for colorectal polyp diagnosis (n=263). Eighty-four percent of physicians recognized colonoscopy was a very effective screening tool for colorectal cancer/polyp, while FOBT was recognized as an ineffective screening tool by 57% of physicians.
DCBE, double contrast barium enema; FOBT, fecal occult blood test.
kjg-60-26-g003
Fig. 4
Physician's modality-specific recommendations for colorectal polyp screening (n=263). Multiple choices were allowed. Ninety-eight percent of physicians recommend screening colonoscopy to asymptomatic, average-risk patients as a first choice. Only 2% of physicians choose sigmoidoscopy as a screening tool.
CFS, colonoscopy; CTC, CT colonography; FOBT, fecal occult blood test; Sig, Sigmoidoscoy; DCBE, double contrast barium enema.
kjg-60-26-g004
Fig. 5
Physicians' action for a detected polyp at screening colonoscopy. For polyps smaller than 0.5 cm, 84% of physicians removed them immediately after the detection using biopsy forcep. For polyps larger than 1.0 cm, 54.4% of physicians removed them with one-stage polypectomy, 38.4% with two-stage polypectomy.
kjg-60-26-g005
Table 1
Characteristics of the Responders (n=263)
kjg-60-26-i001

Values are n (%) or mean±SD.

aFamily medicine (n=1), preventive medicine (n=1).

Table 2
Physicians' Perceptions of the Effective Starting Age for Colorectal Cancer/Polyp Screening
kjg-60-26-i002

Values are presented as n (%).

CRC, colorectal cancer.

aOthers includes the same age and 10 years younger than age at diagnosis of the affected relative.

Table 3
Subgroup Analysis of Physicians' Action for a Detected Polyp (≥1 cm) at Screening Colonoscopy
kjg-60-26-i003

Values are presented as n (%).

Table 4
Physicians' Recommendation for Colonoscopic Follow-up after Initial Negative Examination
kjg-60-26-i004

Values are presented as n (%).

Notes

Financial support: This study was supported by a grant of the Korean Health Technology R&D Project, Ministry for Health, Welfare & Family Affairs (A102065-23).

Notes

Conflict of interest: None.

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