Management of Small Polyps Detected by Screening CT Colonography: Patient and Physician Preferences
Abstract
Background
Management of small polyps found on computed tomography (CT) colonography is controversial and critical to both cancer outcomes and cost. Patient and physician behavior are influenced by personal beliefs and prior experience. Thus, we aimed to understand patient and physician preferences after finding polyps on CT colonography.
Methods
Patients were given a validated handout and survey asking for their preference for evaluation of a “pea-sized” polyp found on CT colonography. By using an Internet survey, physicians were asked how they would manage a 5-mm, 8-mm, or 12-mm polyp, or three 5-mm polyps found by CT colonography in a hypothetical 52-year-old patient of average colorectal cancer risk. Survey reliability was assessed using Cronbach's coefficient alpha.
Results
Of the 305 patient respondents, 95% wanted to know if the polyp found on CT colonography was precancerous, 86% stated they would request endoscopic evaluation, and 85% wanted polypectomy. Of the 277 primary care physicians, 71% would refer a 5-mm sigmoid polyp for endoscopy, 86% would refer an 8-mm polyp, 97% would refer a 12-mm polyp, and 91% would refer three 5-mm polyps. Of the 461 gastroenterologists, 83% would refer a 5-mm sigmoid polyp for endoscopy, 96% would refer an 8-mm polyp, 97% would refer a 12-mm polyp, and 93% would refer three 5-mm polyps. Overall, 75% of physicians indicated the fear of missing a precancerous lesion would prompt referral for colonoscopy.
Conclusion
Both patients and physicians overwhelmingly preferred to follow up small polyps identified by CT colonography with endoscopy, suggesting that population-based CT colonography screening programs in which polyps are not removed might require significant patient and physician education before implementation.
aDivision of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas
bDepartment of Clinical Sciences (Biostatistics), University of Texas Southwestern Medical Center, Dallas
Requests for reprints should be addressed to Don C. Rockey, MD, University of Texas Southwestern Medical Center, Division of Digestive and Liver Diseases, 5323 Harry Hines Blvd, Dallas, TX 75390-8887
Funding: Dr Shah was supported in part by a National Institutes of Health research grant (NIH T32-DK07745).
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.
ABSTRACT
