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Good News

Good News: Colorectal Cancer (CRC) has been renamed: It is the preventable cancer. Surprisingly, it remains the number one cancer killer among non-smokers, claiming more lives that breast or prostate cancer. It doesn’t have to be. In a recent study published in the International Journal of Cancer, a medical group (Carolina Colonoscopy Center) in Columbia, SC achieved an 83% reduction in the risk of developing colon cancer and a nearly 90% reduction in deaths. To put these startling statistics into focus, this means that if all Americans followed the American Cancer Society recommendations and had colonoscopies at the quality level achieved in Columbia, 40,000 less deaths would occur each year. Colon cancer is a very expensive way to die. The average cost is over $300,000. So reducing the cancer rate by thorough removal of pre-cancerous polyps could actually save billions. More than 23,000,000 have never been tested. This is too often a fatal mistake. If a patient waits until they have even the first symptom, 85% die.

Bad News: The quality achieved in Columbia, SC is not universal. Yes, there is a simple to measure yardstick for quality in colonoscopy screening. The “adenoma detection rate” or ADR has long been the industry standard measure of quality. The American College of Gastroenterology web site extolls the virtue of this value. An article in the New England Journal of Medicine demonstrated a ten-fold increase in protection from CRC if a physician achieved the industry standard minimum ADR. The sad fact is that no one requires doctors to measure it. Most doctors practice in groups and if some members are below the standard, the remainder are loathe to publish statistics that in essence reveals the inadequacy of their colleagues. So the public suffers. A simple measurement that could produce a ten-fold increase in protection is systematically withheld from the public to protect the partners of some very well to do doctors. It appears that the low quality performers are usually faster, so they do a disproportionate number of tests. It may be that as many as half of the tests performed in America are by doctors below the established minimum (ADR equal to or above 25%).

Stephen C. Lloyd, M.D., Ph.D.

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