35 research outputs found

    Who Is at Risk for Early-Onset Colorectal Cancer?

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    Modern medical decision making, whether preventive, diagnostic, or therapeutic, emphasizes the risk stratification of patients, and is heavily informed and influenced by evidence-based guidelines. Such guidelines for colorectal cancer (CRC) screening were first published in 1997,1 and subsequently by multiple professional organizations. Although there have been disagreements regarding choice of screening modality, the start age of 50 years for most average-risk individuals (with the notable exception of African Americans) has been mostly unchallenged

    Patients’ Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey

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    Background: In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. Methods: We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. Results: Despite a physician recommendation to stop screening, 29% of respondents reported being "not at all likely" to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. Conclusion: Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources

    AGA Institute Quality Measure Development for the Management of Gastric Intestinal Metaplasia with Helicobacter pylori

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    Gastric cancer is the third leading cause of cancer-related deaths worldwide, with more than 1 million incident cases diagnosed globally. 1 Non-cardia intestinal-type gastric cancer, the most common subtype of gastric cancer, develops through the Correa cascade in which chronic inflammation of normal gastric mucosa leads to atrophic gastritis, followed by gastric intestinal metaplasia (GIM), dysplasia, and ultimately gastric cancer. 2 GIM has an estimated prevalence of 4.8% in the United States based on an analysis of gastric biopsies from a large pathology database, but higher rates of GIM have been reported in certain racial and ethnic groups (14.8% in Asian Americans, 18.2% in Native Americans, 25.5% in African Americans, and 29.5% in Hispanic Americans). 3 ,4 Additional risk factors for GIM include tobacco use, autoimmune gastritis, and living or immigrating from an endemic area. The annual risk of progression from GIM to non-cardia intestinal-type gastric cancer is 0.16%, and factors such as persistent Helicobacter pylori infection, family history, anatomic extent and location of GIM, and histologic subtypes may confer increased risk of progression to gastric cancer. 5 Studies of U.S. endoscopists show variation in the management of patients with GIM, including use and interval for endoscopic surveillance, prompting the development of guidelines for the management of GIM

    Patients’ Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey

    No full text
    Background: In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. Methods: We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. Results: Despite a physician recommendation to stop screening, 29% of respondents reported being "not at all likely" to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. Conclusion: Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources
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