Journal List > Korean J Gastroenterol > v.60(1) > 1007011

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



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.


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%).


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.


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.

Figures and Tables

Fig. 1
Questionnaire about physician's perceptions and recommendations for colorectal cancer/polyp screening.
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.
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.
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.
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.
Table 1
Characteristics of the Responders (n=263)

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

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

Values are presented as n (%).

Table 4
Physicians' Recommendation for Colonoscopic Follow-up after Initial Negative Examination

Values are presented as n (%).


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).


Conflict of interest: None.


1. Jung KW, Park S, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality and survival in 2006-2007. J Korean Med Sci. 2010. 25:1113–1121.
2. Shin HR, Won YJ, Jung KW, et al. Nationwide cancer incidence in Korea, 1999~2001; first result using the national cancer incidence database. Cancer Res Treat. 2005. 37:325–331.
3. Winawer S, Fletcher R, Rex D, et al. Gastrointestinal Consortium Panel. Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology. 2003. 124:544–560.
4. Lee BH, Jeong SY. Korean National Recommendation Guidelines on Screening and Surveillance for Early Detection of Colorectal Cancers. J Korean Med Assoc. 2002. 45:981–991.
5. Hong SN, Yang DH, Kim YH, et al. Multi-society task force for the guidelines for colorectal polyp screening, surveillance and management. A Survey for post-polypectomy surveillance. Intest Res. 2011. 9:118–128.
6. Arditi C, Peytremann-Bridevaux I, Burnand B, et al. EPAGE II Study Group. Appropriateness of colonoscopy in Europe (EPAGE II). Screening for colorectal cancer. Endoscopy. 2009. 41:200–208.
7. Davila RE, Rajan E, Baron TH, et al. Standards of Practice Committee, American Society for Gastrointestinal Endoscopy. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc. 2006. 63:546–557.
8. Bond JH. Practice Parameters Committee of the American College of Gastroenterology. Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps. Am J Gastroenterol. 2000. 95:3053–3063.
9. Levin B, Lieberman DA, McFarland B, et al. American Cancer Society Colorectal Cancer Advisory Group. US Multi-Society Task Force. American College of Radiology Colon Cancer Committee. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008. 134:1570–1595.
10. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009. 104:739–750.
11. U.S. Preventive Services Task Force. Screening for colorectal cancer: recommendation and rationale. Am Fam Physician. 2002. 66:2287–2290.
12. Park DI, Ryu S, Kim YH, et al. Comparison of guaiac-based and quantitative immunochemical fecal occult blood testing in a population at average risk undergoing colorectal cancer screening. Am J Gastroenterol. 2010. 105:2017–2025.
13. Lee SH, Lee KS, Lee JY, et al. Clinical usefulness of fecal occult blood test as a screening method for asymptomatic patients with colon polyps. Korean J Gastroenterol. 2006. 48:388–394.
14. Morikawa T, Kato J, Yamaji Y, Wada R, Mitsushima T, Shiratori Y. A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology. 2005. 129:422–428.
15. Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008. 359:1207–1217.
16. Pickhardt PJ, Hanson ME, Vanness DJ, et al. Unsuspected extracolonic findings at screening CT colonography: clinical and economic impact. Radiology. 2008. 249:151–159.
17. Gluecker TM, Johnson CD, Wilson LA, et al. Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology. 2003. 124:911–916.
18. Lewis JD, Ng K, Hung KE, et al. Detection of proximal adenomatous polyps with screening sigmoidoscopy: a systematic review and meta-analysis of screening colonoscopy. Arch Intern Med. 2003. 163:413–420.
19. Griffith JM, Lewis CL, Brenner AR, Pignone MP. The effect of offering different numbers of colorectal cancer screening test options in a decision aid: a pilot randomized trial. BMC Med Inform Decis Mak. 2008. 8:4.
20. Atkin WS, Edwards R, Kralj-Hans I, et al. UK Flexible Sigmoidoscopy Trial Investigators. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet. 2010. 375:1624–1633.
21. Singh H, Turner D, Xue L, Targownik LE, Bernstein CN. Risk of developing colorectal cancer following a negative colonoscopy examination: evidence for a 10-year interval between colonoscopies. JAMA. 2006. 295:2366–2373.
22. Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology. 2007. 132:96–102.
23. Lakoff J, Paszat LF, Saskin R, Rabeneck L. Risk of developing proximal versus distal colorectal cancer after a negative colonoscopy: a population-based study. Clin Gastroenterol Hepatol. 2008. 6:1117–1121.
24. Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009. 150:1–8.
25. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Results of screening colonoscopy among persons 40 to 49 years of age. N Engl J Med. 2002. 346:1781–1785.
26. Lieberman DA, Holub JL, Moravec MD, Eisen GM, Peters D, Morris CD. Prevalence of colon polyps detected by colonoscopy screening in asymptomatic black and white patients. JAMA. 2008. 300:1417–1422.
27. Betés M, Muñoz-Navas MA, Duque JM, et al. Use of colonoscopy as a primary screening test for colorectal cancer in average risk people. Am J Gastroenterol. 2003. 98:2648–2654.
28. Choe JW, Chang HS, Yang SK, et al. Screening colonoscopy in asymptomatic average-risk Koreans: analysis in relation to age and sex. J Gastroenterol Hepatol. 2007. 22:1003–1008.
29. Lieberman D. Endoscopic colon screening: is less more? Gastroenterology. 1996. 111:1385–1387.
30. Sung JJ, Lau JY, Young GP, et al. Asia Pacific Working Group on Colorectal Cancer. Asia Pacific consensus recommendations for colorectal cancer screening. Gut. 2008. 57:1166–1176.
31. Levin B, Lieberman DA, McFarland B, et al. American Cancer Society Colorectal Cancer Advisory Group. US Multi-Society Task Force. American College of Radiology Colon Cancer Committee. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008. 58:130–160.
32. Morson BC. Evolution of cancer of the colon and rectum. Cancer. 1974. 34:Suppl. 845–849.
33. Kato H, Haga S, Endo S, et al. Lifting of lesions during endoscopic mucosal resection (EMR) of early colorectal cancer: implications for the assessment of resectability. Endoscopy. 2001. 33:568–573.
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