Easy-to-Miss Lesions Most Likely To Turn Cancerous

A new study of colonoscopy suggests that flat, hard-to-spot lesions in the colon are the most likely to become cancerous.

American doctors have been aware of these lesions for a couple of decades. But until recently, there was little reason to think that they were dangerous when occurring in America, although studies done in Japan did reveal dangers. This new American study showed that flat or indented lesions were five times as likely to be cancerous than as polyps, which are much easier for doctors to spot.

From the article:

People who have just had a colonoscopy should not rush to schedule another one just to look for the flat growths, doctors said.

“I don’t think people have to panic that they’ve somehow been neglected and had poor care,” said Dr. David A. Rothenberger, deputy chairman of surgery at the University of Minnesota.

But he and other experts emphasized that people should see a doctor any time they have persisting symptoms that could indicate colon cancer, like rectal bleeding or a change in bowel habits – no matter how recently they had a colonoscopy. The test is highly reliable, but not perfect, doctors say.

Furthermore, some doctors have a hard time spotting even polyps: as the article says, a December 2006 study showed that some doctors are 10 times better than others at finding pre-cancerous polyps, and the difference largely had to do with whether the doctor took care doing the procedure or attempted to rush things.

Unfortunately, it is always difficult and often impossible to find a doctor’s track record on this issue. Again, from the article:

The difficulty facing patients is how to be sure their doctors are doing a good job. Professional groups have issued guidelines about the best way to perform a colonoscopy, but they are recommendations, not rules. The groups also urge doctors to track their own success rates at finding precancerous growths to see how they measure up to standards, but even if they do keep track, the doctors do not have to share the data with anyone. And many people are loath to ask about it. The doctor wielding the scope is the last person most patients would want to offend.

“The patient really has no way to act as an informed consumer,” Dr. Smith said. “You can’t call up a facility and say, ‘By the way, is my doctor any good?’ or, ‘Tell me who the best one is.’ “

It is important to remember that not all doctors are offended by questions about their track records, and that giving offense is less important than safe-guarding your own health. This is especially true if you have a choice of which doctor to go to, because that way you will not be stuck with a health care provider who might have been offended by your inquiries.

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