One of the less-welcome birthday gifts you'll likely get when you turn 50 is a reminder from your doctor that it's time to schedule your first colonoscopy. This is a very important screening, and if everyone received one, deaths from colorectal cancer would likely drop dramatically. However, I know the process of getting this screening isn't exactly pleasant. That's why it's important to find a doctor who will do the best possible job for you so that the test is worthwhile.
A number of different types of doctors can perform colonoscopies, including primary care doctors, general surgeons, and gastroenterologists. But they're all human, and some tend to be better than others. While gastroenterologists as a whole tend to be the best because of their specialty, you can still find a wide range of skill from doctor to doctor. So your primary care doctor could actually be your best bet. Fortunately, there's a good way to gauge whether or not your doctor knows what to look for while performing your screening.
As your doctor evaluates your colon, one of the things he or she is looking for is an adenoma, a type of polyp that can become cancerous. However, adenomas can be hard to spot. Doctors can track their ability to find them according to a measurement called an adenoma detection rate (ADR). The ADR indicates the percentage of patients in whom a doctor finds an adenoma.
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Of course, not everyone has adenomas. If we did, colorectal cancer would probably be a much more likely possibility for all of us. So your doctor doesn't need to have an ADR of 100% — nowhere near that, in fact. If your doctor has an ADR of 20% or higher for women and 30% or higher for men (who typically have more adenomas), you can trust that he or she probably knows what to look for. An ADR of 25% or higher across the board (i.e., not divided by gender) is also acceptable.
The ADR score truly can make a difference. In fact, a study published in The New England Journal of Medicine looked at over 300,000 colonoscopies that 136 gastroenterologists conducted over the course of 10 years. Remember, this type of doctor is supposed to be the expert. But the researchers still found that for every 1% increase in a doctor's ADR, his or her patients' risk of developing colorectal cancer before their next colonoscopies dropped by 3%. So it's clearly worthwhile to seek out a doctor with a strong ADR.
When you're scheduling your screening, be sure to ask about the doctor's ADR. The office staff or a nurse can often provide this information. Some doctors don't keep track of this measure, as it's not legally mandated, and others refuse to provide their numbers. If either of these are true of your doctor, but particularly the latter, it's worth looking elsewhere to find a doctor to conduct the screening. If you do have an adenoma, you certainly don't want to go through the discomfort of a colonoscopy only to have your doctor miss it, putting you at risk of cancer.
Yours for better health,
Frank Shallenberger, MD
Source:
http://www.nejm.org/doi/full/10.1056/NEJMoa1309086#t=article.