Colon Cancer Screening More Effective Earlier In The Day
November 5, 2009
According to a new UCLA study, early-morning colonoscopies yielded more polyps per patient than later screenings. "Our research was conducted at an academic-affiliated facility that far exceeds published quality benchmarks for colonoscopy outcomes," said study author Dr. Brennan M.R. Spiegel, director of the UCLA/Veterans Affairs Center for Outcomes Research and Education. "If this is occurring at such a high-performing academic center, it is probably happening at other facilities across the country." Other studies have reached similar conclusions, including recent research from the Cleveland Clinic. "Successful colonoscopy procedures depend on a number of key patient, provider and procedural factors—and time of day may also be important as well," said Spiegel, assistant professor of digestive diseases at the David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Healthcare System. Researchers tracked 477 patients receiving colonoscopies over the course of one year at a single VA hospital and found that cases started at 8:30 am or earlier, yielded 27 percent more polyps—0.19 more overall polyps and 0.17 more premalignant polyps—per patient than later cases. The amount of polyps discovered decreased hour by hour as the day progressed. This translates into less than a quarter of a polyp per patient. "Although individual patient risk is very low, multiplying this effect by thousands of patients across the United States could mean we’re missing lots of polyps, some of which might turn into cancer one day," Spiegel said. Spiegel added that colonoscopy remains a highly effective means of screening for colon cancer whatever the time of day and warned against patients insisting on being the first case of the day. "Patients should feel confident that colonoscopy is helpful regardless of time of day and should be more focused on the quality and experience of their doctor rather than the time of their appointment." Though colonoscopies performed in the morning may have better results partly due to improved bowel preparation the night before, that didn’t completely explain the overall study results. Spiegel said that fatigue may play a role. "We may find that setting a cap on the duration of endoscopic work shifts or other types of adjustments may be helpful," he said.