Richard Hyer

CHICAGO – Eating bars rich in flaxseed failed to reduce hot flashes for postmenopausal women in a randomized, placebo-controlled, phase III trial conducted by the North Central Cancer Treatment Group.

Mean hot flash scores fell comparably in both arms of the study, which enrolled breast cancer patients and women who never had the disease. Instead of relief from this troubling symptom, many participants reported GI distress.

"Our findings do not support the use of 410 mg of flaxseed lignans for the reduction of hot flashes. The gastrointestinal side effects seen in both groups were more likely due to the fiber content in the flaxseed and the placebo bars," said Dr. Sandhya Pruthi of the Mayo Clinic in Rochester, Minn. She presented the results at the annual meeting of the American Society of Clinical Oncology.

"Because hot flashes can negatively impact quality of life for many women, there is increasing interest in the use of complementary therapies such as flaxseed," Dr. Pruthi said, laying out the rationale for the trial.

Flaxseed is an annual plant, rich in lignans, which are a major class of phytoestrogens, she said. It is thought to have a weak estrogenlike effect, as well as estrogen antagonist effect.

In 2005, a pilot study of flaxseed was conducted in 30 women. They were given 400 mg of ground flaxseed, and investigators reported a 57% reduction in hot flash scores and a 50% reduction in hot flash frequency. This – along with a patient who claimed that flaxseed was successful in treating her hot flashes – led to the current trial, said Dr. Pruthi.

To be eligible, women with or without a history of breast cancer had to have more than 28 hot flashes per week. In all, 188 women were enrolled and 178 were randomized (88 to flaxseed bars containing 410 mg of lignans and fiber, and 90 to placebo bars containing protein and fiber, but no flaxseed, soy, or lignans). For 6 weeks, the participants were to eat one bar per day. The primary end point was a change from baseline in hot flash scores at week 6.

Of the entire group, 91 had a history of breast cancer but were without active disease. This group included women who were being treated with an aromatase inhibitor or tamoxifen.

Mean hot flash scores decreased by 4.9 units (about 33%) in the flaxseed arm, and 3.5 (about 29%) in the placebo arm (P = .29). "There was no significant difference in the reduction of hot flash scores between the two arms," said Dr. Pruthi.

No statistically significant toxicity was experienced by women in either arm, but both groups reported abdominal distention, gas, diarrhea, and nausea.

Although the results were disappointing, the trial does not leave women without remedies for hot flashes. Dr. Pruthi noted that venlafaxine and gabapentin were effective, and had been studied in randomized, placebo-controlled trials. "So we do have options for women who are not wanting to take hormonal therapies like estrogen or progesterone, especially with a history of breast cancer," she said.

"However, there are side effects with those drugs. Patients need to balance between treating their symptoms and managing their side effects, which is why we need to do more studies in other complementary therapies that we think might have [fewer side effects] and still give us the benefit of treating hot flashes," she said.

Dr. Pruthi reported having nothing to disclose. This study was funded by the National Cancer Institute.

CHICAGO – Eating bars rich in flaxseed failed to reduce hot flashes for postmenopausal women in a randomized, placebo-controlled, phase III trial conducted by the North Central Cancer Treatment Group.

Mean hot flash scores fell comparably in both arms of the study, which enrolled breast cancer patients and women who never had the disease. Instead of relief from this troubling symptom, many participants reported GI distress.

"Our findings do not support the use of 410 mg of flaxseed lignans for the reduction of hot flashes. The gastrointestinal side effects seen in both groups were more likely due to the fiber content in the flaxseed and the placebo bars," said Dr. Sandhya Pruthi of the Mayo Clinic in Rochester, Minn. She presented the results at the annual meeting of the American Society of Clinical Oncology.

"Because hot flashes can negatively impact quality of life for many women, there is increasing interest in the use of complementary therapies such as flaxseed," Dr. Pruthi said, laying out the rationale for the trial.

Flaxseed is an annual plant, rich in lignans, which are a major class of phytoestrogens, she said. It is thought to have a weak estrogenlike effect, as well as estrogen antagonist effect.

In 2005, a pilot study of flaxseed was conducted in 30 women. They were given 400 mg of ground flaxseed, and investigators reported a 57% reduction in hot flash scores and a 50% reduction in hot flash frequency. This – along with a patient who claimed that flaxseed was successful in treating her hot flashes – led to the current trial, said Dr. Pruthi.

To be eligible, women with or without a history of breast cancer had to have more than 28 hot flashes per week. In all, 188 women were enrolled and 178 were randomized (88 to flaxseed bars containing 410 mg of lignans and fiber, and 90 to placebo bars containing protein and fiber, but no flaxseed, soy, or lignans). For 6 weeks, the participants were to eat one bar per day. The primary end point was a change from baseline in hot flash scores at week 6.

Of the entire group, 91 had a history of breast cancer but were without active disease. This group included women who were being treated with an aromatase inhibitor or tamoxifen.

Mean hot flash scores decreased by 4.9 units (about 33%) in the flaxseed arm, and 3.5 (about 29%) in the placebo arm (P = .29). "There was no significant difference in the reduction of hot flash scores between the two arms," said Dr. Pruthi.

No statistically significant toxicity was experienced by women in either arm, but both groups reported abdominal distention, gas, diarrhea, and nausea.

Although the results were disappointing, the trial does not leave women without remedies for hot flashes. Dr. Pruthi noted that venlafaxine and gabapentin were effective, and had been studied in randomized, placebo-controlled trials. "So we do have options for women who are not wanting to take hormonal therapies like estrogen or progesterone, especially with a history of breast cancer," she said.

"However, there are side effects with those drugs. Patients need to balance between treating their symptoms and managing their side effects, which is why we need to do more studies in other complementary therapies that we think might have [fewer side effects] and still give us the benefit of treating hot flashes," she said.

Dr. Pruthi reported having nothing to disclose. This study was funded by the National Cancer Institute.

CHICAGO – Eating bars rich in flaxseed failed to reduce hot flashes for postmenopausal women in a randomized, placebo-controlled, phase III trial conducted by the North Central Cancer Treatment Group.

Mean hot flash scores fell comparably in both arms of the study, which enrolled breast cancer patients and women who never had the disease. Instead of relief from this troubling symptom, many participants reported GI distress.

"Our findings do not support the use of 410 mg of flaxseed lignans for the reduction of hot flashes. The gastrointestinal side effects seen in both groups were more likely due to the fiber content in the flaxseed and the placebo bars," said Dr. Sandhya Pruthi of the Mayo Clinic in Rochester, Minn. She presented the results at the annual meeting of the American Society of Clinical Oncology.

"Because hot flashes can negatively impact quality of life for many women, there is increasing interest in the use of complementary therapies such as flaxseed," Dr. Pruthi said, laying out the rationale for the trial.

Flaxseed is an annual plant, rich in lignans, which are a major class of phytoestrogens, she said. It is thought to have a weak estrogenlike effect, as well as estrogen antagonist effect.

In 2005, a pilot study of flaxseed was conducted in 30 women. They were given 400 mg of ground flaxseed, and investigators reported a 57% reduction in hot flash scores and a 50% reduction in hot flash frequency. This – along with a patient who claimed that flaxseed was successful in treating her hot flashes – led to the current trial, said Dr. Pruthi.

To be eligible, women with or without a history of breast cancer had to have more than 28 hot flashes per week. In all, 188 women were enrolled and 178 were randomized (88 to flaxseed bars containing 410 mg of lignans and fiber, and 90 to placebo bars containing protein and fiber, but no flaxseed, soy, or lignans). For 6 weeks, the participants were to eat one bar per day. The primary end point was a change from baseline in hot flash scores at week 6.

Of the entire group, 91 had a history of breast cancer but were without active disease. This group included women who were being treated with an aromatase inhibitor or tamoxifen.

Mean hot flash scores decreased by 4.9 units (about 33%) in the flaxseed arm, and 3.5 (about 29%) in the placebo arm (P = .29). "There was no significant difference in the reduction of hot flash scores between the two arms," said Dr. Pruthi.

No statistically significant toxicity was experienced by women in either arm, but both groups reported abdominal distention, gas, diarrhea, and nausea.

Although the results were disappointing, the trial does not leave women without remedies for hot flashes. Dr. Pruthi noted that venlafaxine and gabapentin were effective, and had been studied in randomized, placebo-controlled trials. "So we do have options for women who are not wanting to take hormonal therapies like estrogen or progesterone, especially with a history of breast cancer," she said.

"However, there are side effects with those drugs. Patients need to balance between treating their symptoms and managing their side effects, which is why we need to do more studies in other complementary therapies that we think might have [fewer side effects] and still give us the benefit of treating hot flashes," she said.

Dr. Pruthi reported having nothing to disclose. This study was funded by the National Cancer Institute.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians presented at the annual meeting of the American Society of Clinical Oncology.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

"Increased coordination of care is needed to ensure continuity of care," said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute. "Yet barriers to achieving care remain in our fragmented health care system."

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

"Bivariate results show that the physicians’ specialty was significantly associated with all five barriers," Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians. More primary care physicians said fear of malpractice was sometimes (40% versus 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, versus 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

"PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems," said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases).

For primary care physicians and oncologists, duplicated care was never or rarely an issue (52% versus 44%, respectively), sometimes a problem (37% vs. 43%), and often/always a problem (11% vs. 13%), she said. (P = .0035 in all cases).

"Medical oncologists were also significantly more likely to report, often/always and sometimes, concerns about which physician is providing general preventive care services," said Dr. Virgo.

Physicians included in the survey had to practice in a nonfederal setting, be 76 years of age or younger, and dedicate at least 20% of their professional time to patient care. Additional criteria were specific to the specialty: medical oncologists must have cared for breast or colon cancer patients within the past year, and primary care physicians must have had office-based practices.

Dr. Virgo reported no relevant financial conflicts.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians presented at the annual meeting of the American Society of Clinical Oncology.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

"Increased coordination of care is needed to ensure continuity of care," said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute. "Yet barriers to achieving care remain in our fragmented health care system."

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

"Bivariate results show that the physicians’ specialty was significantly associated with all five barriers," Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians. More primary care physicians said fear of malpractice was sometimes (40% versus 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, versus 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

"PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems," said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases).

For primary care physicians and oncologists, duplicated care was never or rarely an issue (52% versus 44%, respectively), sometimes a problem (37% vs. 43%), and often/always a problem (11% vs. 13%), she said. (P = .0035 in all cases).

"Medical oncologists were also significantly more likely to report, often/always and sometimes, concerns about which physician is providing general preventive care services," said Dr. Virgo.

Physicians included in the survey had to practice in a nonfederal setting, be 76 years of age or younger, and dedicate at least 20% of their professional time to patient care. Additional criteria were specific to the specialty: medical oncologists must have cared for breast or colon cancer patients within the past year, and primary care physicians must have had office-based practices.

Dr. Virgo reported no relevant financial conflicts.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians presented at the annual meeting of the American Society of Clinical Oncology.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

"Increased coordination of care is needed to ensure continuity of care," said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute. "Yet barriers to achieving care remain in our fragmented health care system."

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

"Bivariate results show that the physicians’ specialty was significantly associated with all five barriers," Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians. More primary care physicians said fear of malpractice was sometimes (40% versus 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, versus 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

"PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems," said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases).

For primary care physicians and oncologists, duplicated care was never or rarely an issue (52% versus 44%, respectively), sometimes a problem (37% vs. 43%), and often/always a problem (11% vs. 13%), she said. (P = .0035 in all cases).

"Medical oncologists were also significantly more likely to report, often/always and sometimes, concerns about which physician is providing general preventive care services," said Dr. Virgo.

Physicians included in the survey had to practice in a nonfederal setting, be 76 years of age or younger, and dedicate at least 20% of their professional time to patient care. Additional criteria were specific to the specialty: medical oncologists must have cared for breast or colon cancer patients within the past year, and primary care physicians must have had office-based practices.

Dr. Virgo reported no relevant financial conflicts.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians presented at the annual meeting of the American Society of Clinical Oncology.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

"Increased coordination of care is needed to ensure continuity of care," said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute. "Yet barriers to achieving care remain in our fragmented health care system."

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

"Bivariate results show that the physicians’ specialty was significantly associated with all five barriers," Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians. More primary care physicians said fear of malpractice was sometimes (40% versus 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, versus 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

"PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems," said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases).

For primary care physicians and oncologists, duplicated care was never or rarely an issue (52% versus 44%, respectively), sometimes a problem (37% vs. 43%), and often/always a problem (11% vs. 13%), she said. (P = .0035 in all cases).

"Medical oncologists were also significantly more likely to report, often/always and sometimes, concerns about which physician is providing general preventive care services," said Dr. Virgo.

Physicians included in the survey had to practice in a nonfederal setting, be 76 years of age or younger, and dedicate at least 20% of their professional time to patient care. Additional criteria were specific to the specialty: medical oncologists must have cared for breast or colon cancer patients within the past year, and primary care physicians must have had office-based practices.

Dr. Virgo reported no relevant financial conflicts.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians presented at the annual meeting of the American Society of Clinical Oncology.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

"Increased coordination of care is needed to ensure continuity of care," said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute. "Yet barriers to achieving care remain in our fragmented health care system."

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

"Bivariate results show that the physicians’ specialty was significantly associated with all five barriers," Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians. More primary care physicians said fear of malpractice was sometimes (40% versus 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, versus 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

"PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems," said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases).

For primary care physicians and oncologists, duplicated care was never or rarely an issue (52% versus 44%, respectively), sometimes a problem (37% vs. 43%), and often/always a problem (11% vs. 13%), she said. (P = .0035 in all cases).

"Medical oncologists were also significantly more likely to report, often/always and sometimes, concerns about which physician is providing general preventive care services," said Dr. Virgo.

Physicians included in the survey had to practice in a nonfederal setting, be 76 years of age or younger, and dedicate at least 20% of their professional time to patient care. Additional criteria were specific to the specialty: medical oncologists must have cared for breast or colon cancer patients within the past year, and primary care physicians must have had office-based practices.

Dr. Virgo reported no relevant financial conflicts.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians presented at the annual meeting of the American Society of Clinical Oncology.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

"Increased coordination of care is needed to ensure continuity of care," said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute. "Yet barriers to achieving care remain in our fragmented health care system."

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

"Bivariate results show that the physicians’ specialty was significantly associated with all five barriers," Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians. More primary care physicians said fear of malpractice was sometimes (40% versus 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, versus 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

"PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems," said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases).

For primary care physicians and oncologists, duplicated care was never or rarely an issue (52% versus 44%, respectively), sometimes a problem (37% vs. 43%), and often/always a problem (11% vs. 13%), she said. (P = .0035 in all cases).

"Medical oncologists were also significantly more likely to report, often/always and sometimes, concerns about which physician is providing general preventive care services," said Dr. Virgo.

Physicians included in the survey had to practice in a nonfederal setting, be 76 years of age or younger, and dedicate at least 20% of their professional time to patient care. Additional criteria were specific to the specialty: medical oncologists must have cared for breast or colon cancer patients within the past year, and primary care physicians must have had office-based practices.

Dr. Virgo reported no relevant financial conflicts.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians presented at the annual meeting of the American Society of Clinical Oncology.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

"Increased coordination of care is needed to ensure continuity of care," said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute. "Yet barriers to achieving care remain in our fragmented health care system."

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

"Bivariate results show that the physicians’ specialty was significantly associated with all five barriers," Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians. More primary care physicians said fear of malpractice was sometimes (40% versus 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, versus 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

"PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems," said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases).

For primary care physicians and oncologists, duplicated care was never or rarely an issue (52% versus 44%, respectively), sometimes a problem (37% vs. 43%), and often/always a problem (11% vs. 13%), she said. (P = .0035 in all cases).

"Medical oncologists were also significantly more likely to report, often/always and sometimes, concerns about which physician is providing general preventive care services," said Dr. Virgo.

Physicians included in the survey had to practice in a nonfederal setting, be 76 years of age or younger, and dedicate at least 20% of their professional time to patient care. Additional criteria were specific to the specialty: medical oncologists must have cared for breast or colon cancer patients within the past year, and primary care physicians must have had office-based practices.

Dr. Virgo reported no relevant financial conflicts.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians presented at the annual meeting of the American Society of Clinical Oncology.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

"Increased coordination of care is needed to ensure continuity of care," said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute. "Yet barriers to achieving care remain in our fragmented health care system."

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

"Bivariate results show that the physicians’ specialty was significantly associated with all five barriers," Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians. More primary care physicians said fear of malpractice was sometimes (40% versus 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, versus 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

"PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems," said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases).

For primary care physicians and oncologists, duplicated care was never or rarely an issue (52% versus 44%, respectively), sometimes a problem (37% vs. 43%), and often/always a problem (11% vs. 13%), she said. (P = .0035 in all cases).

"Medical oncologists were also significantly more likely to report, often/always and sometimes, concerns about which physician is providing general preventive care services," said Dr. Virgo.

Physicians included in the survey had to practice in a nonfederal setting, be 76 years of age or younger, and dedicate at least 20% of their professional time to patient care. Additional criteria were specific to the specialty: medical oncologists must have cared for breast or colon cancer patients within the past year, and primary care physicians must have had office-based practices.

Dr. Virgo reported no relevant financial conflicts.

CHICAGO – Primary care physicians and oncologists expressed their concerns about continuity and coordination of care for cancer survivors in a survey of more than 2,000 physicians presented at the annual meeting of the American Society of Clinical Oncology.

The degree of concern about different survivor care issues varied by specialty. For example, primary care physicians were more likely than were oncologists to be concerned about malpractice suits and about a lack of adequate training.

The Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) is the first nationwide study to focus on physician beliefs, knowledge, attitudes and practices regarding breast and colorectal cancer survivorship care.

"Increased coordination of care is needed to ensure continuity of care," said lead author Katherine S. Virgo, Ph.D., director of health services research at the American Cancer Society, which cosponsored the study with the National Cancer Institute. "Yet barriers to achieving care remain in our fragmented health care system."

A total of 1,072 primary care physicians (internists, family physicians, and ob.gyns.) and 1,130 medical oncologists were asked about their perceptions of the barriers to care for survivors of breast and colorectal cancer.

The survey asked about problems encountered when caring for breast or colon cancer survivors who had completed active treatment at least 5 years earlier. Five problem areas were identified in the survey: increased testing as malpractice protection; uncertainty regarding general preventive health care responsibility; duplicated care; missed care; and lack of adequate knowledge or training.

"Bivariate results show that the physicians’ specialty was significantly associated with all five barriers," Dr. Virgo said.

Almost 60% of oncologists said malpractice was never or rarely a barrier, versus almost 50% of primary care physicians. More primary care physicians said fear of malpractice was sometimes (40% versus 31%) or often/always (16% vs. 10%) a barrier, (P less than .001 in all cases).

As for missed care, 43% of primary care physicians said it was never/rarely an issue, versus 40% of oncologists. More oncologists said it was sometimes an issue (48% vs. 42%), but more primary care physicians said it was often or always (15% vs. 12%) an issue, (P less than .0047 in all cases).

"PCPs were also significantly more likely to be concerned about lacking adequate training to manage patient problems," said Dr. Virgo.

Indeed, almost 90% of oncologists said lack of training was never or rarely an issue, versus 54% of primary care physicians (P less than .0001 in all cases).

For primary care physicians and oncologists, duplicated care was never or rarely an issue (52% versus 44%, respectively), sometimes a problem (37% vs. 43%), and often/always a problem (11% vs. 13%), she said. (P = .0035 in all cases).

"Medical oncologists were also significantly more likely to report, often/always and sometimes, concerns about which physician is providing general preventive care services," said Dr. Virgo.

Physicians included in the survey had to practice in a nonfederal setting, be 76 years of age or younger, and dedicate at least 20% of their professional time to patient care. Additional criteria were specific to the specialty: medical oncologists must have cared for breast or colon cancer patients within the past year, and primary care physicians must have had office-based practices.

Dr. Virgo reported no relevant financial conflicts.

CHICAGO – A retrospective chart review of 1,218 cases at one institution suggests that nearly two-thirds of the colorectal cancers that occur in the interval between colonoscopies are lesions that were missed or incompletely removed during the previous colonoscopy.

"Operator-dependant variability with regards to first detection of colorectal cancer lesions, and effectiveness of treatment, may be a critical factors," according to lead author Chantal le Clercq, a medical student at Maastricht (the Netherlands) University Medical Center, who presented the data at the annual Digestive Disease Week.

All clinical and pathological records of all 1,218 patients diagnosed with colorectal cancer at Maastricht University Medical Center from Jan. 1, 2001 to Dec. 31, 2010 were reviewed. The patient population was 55% men and the mean age was 70 years. Patients with hereditary colorectal cancer, irritable bowel disease, or a previous history of colorectal cancer were excluded from the data analysis.

Cases also were excluded from analysis if records noted incomplete visualization of the colon, poor bowel preparation, or inadequate surveillance according to Dutch guidelines.

Interval colorectal cancers were defined as cancers occurring in the colon and rectum within 5 years of an index colonoscopy. All colorectal cancers were classified as either flat or protruded, and proximal or distal to the splenic flexure.

Interval colorectal cancers were defined as those developing from lesions missed because of a subtle microscopic appearance, such as flat tumors or those smaller than 1 cm, or from those incompletely removed in a previous polypectomy. When neither definition fit, the cause was ruled unclear.

Around 3% (39) of all colorectal cancers developed in patients who had a colonoscopy within the previous 5 years, said Ms. le Clercq. About one-third (11) were excluded from the analysis due to incomplete visualization or inadequate surveillance. About 2% (28) were interval colorectal cancers, which occurred mainly in men (71%) around 70 years old. On average, these cancers were diagnosed 26 months after the index colonoscopy.

The interval colorectal cancers were significantly smaller than noninterval cancers. Nearly 12% were smaller than 1 cm, 19% were 1-2 cm, and the remaining 69% were larger than 2 cm.

Interval colorectal cancers were more likely to be flat lesions than were non–interval colorectal cancers. The Tumor Node Metastasis (TNM) stage and histology were virtually identical. In both cases, more than 70% of procedures were performed by endoscopists.

Multiple logistic regression analysis, adjusted for age and sex, revealed that interval colorectal cancers were more often small (2.7 cm vs. 3.9 cm; odds ratio, 0.82; 95% confidence interval, 0.69-0.97; P = .020). They were more often flat than protruded (48% vs. 21%; OR, 3.75; 95% CI, 1.73-8.13; P = .001). They were more often located in the proximal than the distal colon (70% vs. 33%; OR, 5.07; 95% CI, 2.18-11.8; P less than .001).

"We found that 54% of cases (n = 15) could be explained by more subtle microscopic appearance. So, these tumors were less than 1 cm in size, or they had a flat appearance, and therefore, these could be explained as potentially missed lesions," said Ms. le Clercq.

Of the remaining 13 cases, 36% (n = 10) had no clear explanation, and nearly 11% (n = 3) could be attributed to incomplete polypectomy, because "they developed in the same [anatomical segment] as a previous polypectomy and therefore could be explained by potentially incomplete removed lesion," said Ms. le Clercq.

Ms. le Clercq said that 2.2% (1 of 45) of all colorectal cancers diagnosed at her hospital over the past 10 years were interval colorectal cancers. Around 64% of these lesions were related either to lesions that were overlooked, small, or flat, or were incompletely removed.

"These data highlight the need to train practicing endoscopists in the accurate detection and effective treatment of colorectal lesions, to prevent interval colorectal cancers in everyday practice," she said.

Ms. le Clercq disclosed no financial relationship with a commercial interest.

CHICAGO – A retrospective chart review of 1,218 cases at one institution suggests that nearly two-thirds of the colorectal cancers that occur in the interval between colonoscopies are lesions that were missed or incompletely removed during the previous colonoscopy.

"Operator-dependant variability with regards to first detection of colorectal cancer lesions, and effectiveness of treatment, may be a critical factors," according to lead author Chantal le Clercq, a medical student at Maastricht (the Netherlands) University Medical Center, who presented the data at the annual Digestive Disease Week.

All clinical and pathological records of all 1,218 patients diagnosed with colorectal cancer at Maastricht University Medical Center from Jan. 1, 2001 to Dec. 31, 2010 were reviewed. The patient population was 55% men and the mean age was 70 years. Patients with hereditary colorectal cancer, irritable bowel disease, or a previous history of colorectal cancer were excluded from the data analysis.

Cases also were excluded from analysis if records noted incomplete visualization of the colon, poor bowel preparation, or inadequate surveillance according to Dutch guidelines.

Interval colorectal cancers were defined as cancers occurring in the colon and rectum within 5 years of an index colonoscopy. All colorectal cancers were classified as either flat or protruded, and proximal or distal to the splenic flexure.

Interval colorectal cancers were defined as those developing from lesions missed because of a subtle microscopic appearance, such as flat tumors or those smaller than 1 cm, or from those incompletely removed in a previous polypectomy. When neither definition fit, the cause was ruled unclear.

Around 3% (39) of all colorectal cancers developed in patients who had a colonoscopy within the previous 5 years, said Ms. le Clercq. About one-third (11) were excluded from the analysis due to incomplete visualization or inadequate surveillance. About 2% (28) were interval colorectal cancers, which occurred mainly in men (71%) around 70 years old. On average, these cancers were diagnosed 26 months after the index colonoscopy.

The interval colorectal cancers were significantly smaller than noninterval cancers. Nearly 12% were smaller than 1 cm, 19% were 1-2 cm, and the remaining 69% were larger than 2 cm.

Interval colorectal cancers were more likely to be flat lesions than were non–interval colorectal cancers. The Tumor Node Metastasis (TNM) stage and histology were virtually identical. In both cases, more than 70% of procedures were performed by endoscopists.

Multiple logistic regression analysis, adjusted for age and sex, revealed that interval colorectal cancers were more often small (2.7 cm vs. 3.9 cm; odds ratio, 0.82; 95% confidence interval, 0.69-0.97; P = .020). They were more often flat than protruded (48% vs. 21%; OR, 3.75; 95% CI, 1.73-8.13; P = .001). They were more often located in the proximal than the distal colon (70% vs. 33%; OR, 5.07; 95% CI, 2.18-11.8; P less than .001).

"We found that 54% of cases (n = 15) could be explained by more subtle microscopic appearance. So, these tumors were less than 1 cm in size, or they had a flat appearance, and therefore, these could be explained as potentially missed lesions," said Ms. le Clercq.

Of the remaining 13 cases, 36% (n = 10) had no clear explanation, and nearly 11% (n = 3) could be attributed to incomplete polypectomy, because "they developed in the same [anatomical segment] as a previous polypectomy and therefore could be explained by potentially incomplete removed lesion," said Ms. le Clercq.

Ms. le Clercq said that 2.2% (1 of 45) of all colorectal cancers diagnosed at her hospital over the past 10 years were interval colorectal cancers. Around 64% of these lesions were related either to lesions that were overlooked, small, or flat, or were incompletely removed.

"These data highlight the need to train practicing endoscopists in the accurate detection and effective treatment of colorectal lesions, to prevent interval colorectal cancers in everyday practice," she said.

Ms. le Clercq disclosed no financial relationship with a commercial interest.

CHICAGO – A retrospective chart review of 1,218 cases at one institution suggests that nearly two-thirds of the colorectal cancers that occur in the interval between colonoscopies are lesions that were missed or incompletely removed during the previous colonoscopy.

"Operator-dependant variability with regards to first detection of colorectal cancer lesions, and effectiveness of treatment, may be a critical factors," according to lead author Chantal le Clercq, a medical student at Maastricht (the Netherlands) University Medical Center, who presented the data at the annual Digestive Disease Week.

All clinical and pathological records of all 1,218 patients diagnosed with colorectal cancer at Maastricht University Medical Center from Jan. 1, 2001 to Dec. 31, 2010 were reviewed. The patient population was 55% men and the mean age was 70 years. Patients with hereditary colorectal cancer, irritable bowel disease, or a previous history of colorectal cancer were excluded from the data analysis.

Cases also were excluded from analysis if records noted incomplete visualization of the colon, poor bowel preparation, or inadequate surveillance according to Dutch guidelines.

Interval colorectal cancers were defined as cancers occurring in the colon and rectum within 5 years of an index colonoscopy. All colorectal cancers were classified as either flat or protruded, and proximal or distal to the splenic flexure.

Interval colorectal cancers were defined as those developing from lesions missed because of a subtle microscopic appearance, such as flat tumors or those smaller than 1 cm, or from those incompletely removed in a previous polypectomy. When neither definition fit, the cause was ruled unclear.

Around 3% (39) of all colorectal cancers developed in patients who had a colonoscopy within the previous 5 years, said Ms. le Clercq. About one-third (11) were excluded from the analysis due to incomplete visualization or inadequate surveillance. About 2% (28) were interval colorectal cancers, which occurred mainly in men (71%) around 70 years old. On average, these cancers were diagnosed 26 months after the index colonoscopy.

The interval colorectal cancers were significantly smaller than noninterval cancers. Nearly 12% were smaller than 1 cm, 19% were 1-2 cm, and the remaining 69% were larger than 2 cm.

Interval colorectal cancers were more likely to be flat lesions than were non–interval colorectal cancers. The Tumor Node Metastasis (TNM) stage and histology were virtually identical. In both cases, more than 70% of procedures were performed by endoscopists.

Multiple logistic regression analysis, adjusted for age and sex, revealed that interval colorectal cancers were more often small (2.7 cm vs. 3.9 cm; odds ratio, 0.82; 95% confidence interval, 0.69-0.97; P = .020). They were more often flat than protruded (48% vs. 21%; OR, 3.75; 95% CI, 1.73-8.13; P = .001). They were more often located in the proximal than the distal colon (70% vs. 33%; OR, 5.07; 95% CI, 2.18-11.8; P less than .001).

"We found that 54% of cases (n = 15) could be explained by more subtle microscopic appearance. So, these tumors were less than 1 cm in size, or they had a flat appearance, and therefore, these could be explained as potentially missed lesions," said Ms. le Clercq.

Of the remaining 13 cases, 36% (n = 10) had no clear explanation, and nearly 11% (n = 3) could be attributed to incomplete polypectomy, because "they developed in the same [anatomical segment] as a previous polypectomy and therefore could be explained by potentially incomplete removed lesion," said Ms. le Clercq.

Ms. le Clercq said that 2.2% (1 of 45) of all colorectal cancers diagnosed at her hospital over the past 10 years were interval colorectal cancers. Around 64% of these lesions were related either to lesions that were overlooked, small, or flat, or were incompletely removed.

"These data highlight the need to train practicing endoscopists in the accurate detection and effective treatment of colorectal lesions, to prevent interval colorectal cancers in everyday practice," she said.

Ms. le Clercq disclosed no financial relationship with a commercial interest.

CHICAGO – A retrospective chart review of 1,218 cases at one institution suggests that nearly two-thirds of the colorectal cancers that occur in the interval between colonoscopies are lesions that were missed or incompletely removed during the previous colonoscopy.

"Operator-dependant variability with regards to first detection of colorectal cancer lesions, and effectiveness of treatment, may be a critical factors," according to lead author Chantal le Clercq, a medical student at Maastricht (the Netherlands) University Medical Center, who presented the data at the annual Digestive Disease Week.

All clinical and pathological records of all 1,218 patients diagnosed with colorectal cancer at Maastricht University Medical Center from Jan. 1, 2001 to Dec. 31, 2010 were reviewed. The patient population was 55% men and the mean age was 70 years. Patients with hereditary colorectal cancer, irritable bowel disease, or a previous history of colorectal cancer were excluded from the data analysis.

Cases also were excluded from analysis if records noted incomplete visualization of the colon, poor bowel preparation, or inadequate surveillance according to Dutch guidelines.

Interval colorectal cancers were defined as cancers occurring in the colon and rectum within 5 years of an index colonoscopy. All colorectal cancers were classified as either flat or protruded, and proximal or distal to the splenic flexure.

Interval colorectal cancers were defined as those developing from lesions missed because of a subtle microscopic appearance, such as flat tumors or those smaller than 1 cm, or from those incompletely removed in a previous polypectomy. When neither definition fit, the cause was ruled unclear.

Around 3% (39) of all colorectal cancers developed in patients who had a colonoscopy within the previous 5 years, said Ms. le Clercq. About one-third (11) were excluded from the analysis due to incomplete visualization or inadequate surveillance. About 2% (28) were interval colorectal cancers, which occurred mainly in men (71%) around 70 years old. On average, these cancers were diagnosed 26 months after the index colonoscopy.

The interval colorectal cancers were significantly smaller than noninterval cancers. Nearly 12% were smaller than 1 cm, 19% were 1-2 cm, and the remaining 69% were larger than 2 cm.

Interval colorectal cancers were more likely to be flat lesions than were non–interval colorectal cancers. The Tumor Node Metastasis (TNM) stage and histology were virtually identical. In both cases, more than 70% of procedures were performed by endoscopists.

Multiple logistic regression analysis, adjusted for age and sex, revealed that interval colorectal cancers were more often small (2.7 cm vs. 3.9 cm; odds ratio, 0.82; 95% confidence interval, 0.69-0.97; P = .020). They were more often flat than protruded (48% vs. 21%; OR, 3.75; 95% CI, 1.73-8.13; P = .001). They were more often located in the proximal than the distal colon (70% vs. 33%; OR, 5.07; 95% CI, 2.18-11.8; P less than .001).

"We found that 54% of cases (n = 15) could be explained by more subtle microscopic appearance. So, these tumors were less than 1 cm in size, or they had a flat appearance, and therefore, these could be explained as potentially missed lesions," said Ms. le Clercq.

Of the remaining 13 cases, 36% (n = 10) had no clear explanation, and nearly 11% (n = 3) could be attributed to incomplete polypectomy, because "they developed in the same [anatomical segment] as a previous polypectomy and therefore could be explained by potentially incomplete removed lesion," said Ms. le Clercq.

Ms. le Clercq said that 2.2% (1 of 45) of all colorectal cancers diagnosed at her hospital over the past 10 years were interval colorectal cancers. Around 64% of these lesions were related either to lesions that were overlooked, small, or flat, or were incompletely removed.

"These data highlight the need to train practicing endoscopists in the accurate detection and effective treatment of colorectal lesions, to prevent interval colorectal cancers in everyday practice," she said.

Ms. le Clercq disclosed no financial relationship with a commercial interest.

CHICAGO – A retrospective chart review of 1,218 cases at one institution suggests that nearly two-thirds of the colorectal cancers that occur in the interval between colonoscopies are lesions that were missed or incompletely removed during the previous colonoscopy.

"Operator-dependant variability with regards to first detection of colorectal cancer lesions, and effectiveness of treatment, may be a critical factors," according to lead author Chantal le Clercq, a medical student at Maastricht (the Netherlands) University Medical Center, who presented the data at the annual Digestive Disease Week.

All clinical and pathological records of all 1,218 patients diagnosed with colorectal cancer at Maastricht University Medical Center from Jan. 1, 2001 to Dec. 31, 2010 were reviewed. The patient population was 55% men and the mean age was 70 years. Patients with hereditary colorectal cancer, irritable bowel disease, or a previous history of colorectal cancer were excluded from the data analysis.

Cases also were excluded from analysis if records noted incomplete visualization of the colon, poor bowel preparation, or inadequate surveillance according to Dutch guidelines.

Interval colorectal cancers were defined as cancers occurring in the colon and rectum within 5 years of an index colonoscopy. All colorectal cancers were classified as either flat or protruded, and proximal or distal to the splenic flexure.

Interval colorectal cancers were defined as those developing from lesions missed because of a subtle microscopic appearance, such as flat tumors or those smaller than 1 cm, or from those incompletely removed in a previous polypectomy. When neither definition fit, the cause was ruled unclear.

Around 3% (39) of all colorectal cancers developed in patients who had a colonoscopy within the previous 5 years, said Ms. le Clercq. About one-third (11) were excluded from the analysis due to incomplete visualization or inadequate surveillance. About 2% (28) were interval colorectal cancers, which occurred mainly in men (71%) around 70 years old. On average, these cancers were diagnosed 26 months after the index colonoscopy.

The interval colorectal cancers were significantly smaller than noninterval cancers. Nearly 12% were smaller than 1 cm, 19% were 1-2 cm, and the remaining 69% were larger than 2 cm.

Interval colorectal cancers were more likely to be flat lesions than were non–interval colorectal cancers. The Tumor Node Metastasis (TNM) stage and histology were virtually identical. In both cases, more than 70% of procedures were performed by endoscopists.

Multiple logistic regression analysis, adjusted for age and sex, revealed that interval colorectal cancers were more often small (2.7 cm vs. 3.9 cm; odds ratio, 0.82; 95% confidence interval, 0.69-0.97; P = .020). They were more often flat than protruded (48% vs. 21%; OR, 3.75; 95% CI, 1.73-8.13; P = .001). They were more often located in the proximal than the distal colon (70% vs. 33%; OR, 5.07; 95% CI, 2.18-11.8; P less than .001).

"We found that 54% of cases (n = 15) could be explained by more subtle microscopic appearance. So, these tumors were less than 1 cm in size, or they had a flat appearance, and therefore, these could be explained as potentially missed lesions," said Ms. le Clercq.

Of the remaining 13 cases, 36% (n = 10) had no clear explanation, and nearly 11% (n = 3) could be attributed to incomplete polypectomy, because "they developed in the same [anatomical segment] as a previous polypectomy and therefore could be explained by potentially incomplete removed lesion," said Ms. le Clercq.

Ms. le Clercq said that 2.2% (1 of 45) of all colorectal cancers diagnosed at her hospital over the past 10 years were interval colorectal cancers. Around 64% of these lesions were related either to lesions that were overlooked, small, or flat, or were incompletely removed.

"These data highlight the need to train practicing endoscopists in the accurate detection and effective treatment of colorectal lesions, to prevent interval colorectal cancers in everyday practice," she said.

Ms. le Clercq disclosed no financial relationship with a commercial interest.

CHICAGO – A retrospective chart review of 1,218 cases at one institution suggests that nearly two-thirds of the colorectal cancers that occur in the interval between colonoscopies are lesions that were missed or incompletely removed during the previous colonoscopy.

"Operator-dependant variability with regards to first detection of colorectal cancer lesions, and effectiveness of treatment, may be a critical factors," according to lead author Chantal le Clercq, a medical student at Maastricht (the Netherlands) University Medical Center, who presented the data at the annual Digestive Disease Week.

All clinical and pathological records of all 1,218 patients diagnosed with colorectal cancer at Maastricht University Medical Center from Jan. 1, 2001 to Dec. 31, 2010 were reviewed. The patient population was 55% men and the mean age was 70 years. Patients with hereditary colorectal cancer, irritable bowel disease, or a previous history of colorectal cancer were excluded from the data analysis.

Cases also were excluded from analysis if records noted incomplete visualization of the colon, poor bowel preparation, or inadequate surveillance according to Dutch guidelines.

Interval colorectal cancers were defined as cancers occurring in the colon and rectum within 5 years of an index colonoscopy. All colorectal cancers were classified as either flat or protruded, and proximal or distal to the splenic flexure.

Interval colorectal cancers were defined as those developing from lesions missed because of a subtle microscopic appearance, such as flat tumors or those smaller than 1 cm, or from those incompletely removed in a previous polypectomy. When neither definition fit, the cause was ruled unclear.

Around 3% (39) of all colorectal cancers developed in patients who had a colonoscopy within the previous 5 years, said Ms. le Clercq. About one-third (11) were excluded from the analysis due to incomplete visualization or inadequate surveillance. About 2% (28) were interval colorectal cancers, which occurred mainly in men (71%) around 70 years old. On average, these cancers were diagnosed 26 months after the index colonoscopy.

The interval colorectal cancers were significantly smaller than noninterval cancers. Nearly 12% were smaller than 1 cm, 19% were 1-2 cm, and the remaining 69% were larger than 2 cm.

Interval colorectal cancers were more likely to be flat lesions than were non–interval colorectal cancers. The Tumor Node Metastasis (TNM) stage and histology were virtually identical. In both cases, more than 70% of procedures were performed by endoscopists.

Multiple logistic regression analysis, adjusted for age and sex, revealed that interval colorectal cancers were more often small (2.7 cm vs. 3.9 cm; odds ratio, 0.82; 95% confidence interval, 0.69-0.97; P = .020). They were more often flat than protruded (48% vs. 21%; OR, 3.75; 95% CI, 1.73-8.13; P = .001). They were more often located in the proximal than the distal colon (70% vs. 33%; OR, 5.07; 95% CI, 2.18-11.8; P less than .001).

"We found that 54% of cases (n = 15) could be explained by more subtle microscopic appearance. So, these tumors were less than 1 cm in size, or they had a flat appearance, and therefore, these could be explained as potentially missed lesions," said Ms. le Clercq.

Of the remaining 13 cases, 36% (n = 10) had no clear explanation, and nearly 11% (n = 3) could be attributed to incomplete polypectomy, because "they developed in the same [anatomical segment] as a previous polypectomy and therefore could be explained by potentially incomplete removed lesion," said Ms. le Clercq.

Ms. le Clercq said that 2.2% (1 of 45) of all colorectal cancers diagnosed at her hospital over the past 10 years were interval colorectal cancers. Around 64% of these lesions were related either to lesions that were overlooked, small, or flat, or were incompletely removed.

"These data highlight the need to train practicing endoscopists in the accurate detection and effective treatment of colorectal lesions, to prevent interval colorectal cancers in everyday practice," she said.

Ms. le Clercq disclosed no financial relationship with a commercial interest.

CHICAGO – A novel quality indicator called Adenomas Under the Curve might have important advantages over the established metric, the Adenoma Detection Rate, for evaluation of endoscopists’ performance, said Dr. Hank S. Wang at the annual Digestive Disease Week.

The adenoma detection rate (ADR) was developed by the U.S. Multisociety Task Force on Colorectal Cancer and is widely used. However, while it may have strengths, it also has glaring weaknesses – most notably the lack of distinction between detection of one adenoma, and detection of more than one, in a given patient, Dr. Wang said.

"An endoscopist who consistently finds one adenoma per case receives the same credit towards ADR as somebody who consistently finds more than one," said Dr. Wang, a gastroenterology fellow in the division of digestive diseases, University of California, Los Angeles, Training Program.

"Clearly these [two] endoscopists are performing differently, and over a large enough case series, they may even be providing different rates of protection against colorectal cancer. Yet by ADR, they would appear to be identical," he explained.

Use of ADR as a quality measure might actually discourage the search for additional adenomas, said Dr. Wang, or even promote "gaming the quality indicator" to maximize efficiency while still ensuring that credit is received for ADR. Some endoscopists may become less vigilant once they have found the first adenoma, and thus the use of ADR may create a subtle disincentive, he said.

The new metric developed by Dr. Wang and his colleagues, Adenomas Under the Curve (AUC), incorporates ADR data and provides additional quality data on the total number of adenomas detected. Thus AUC extends ADR by capturing data on incremental adenomas beyond the first one detected, said Dr. Wang.

The abstract presented by Dr. Wang compared ADR to AUC in two groups of physicians – academic and community – who were providing screening services for the same pool of patients. Screening colonoscopies were performed over a 4-year period (2005-2009) by two types of practices: a Veterans Affairs teaching hospital endoscopy unit, and a group of three nonteaching, fee-for-service facilities, all serving same population of veterans. The choice of facility was made by the veterans, and the analysis was adjusted for selection bias.

ADR was calculated by dividing the number of cases with one or more adenoma(s) by the total number of cases performed.

In contrast, calculating the AUC involved plotting a histogram showing the frequency of cases and the number of adenomas detected by case. To account for weighting, case frequency was multiplied by the number of adenomas detected per case. When these data were combined, they yielded the measure Adenomas Under the Curve.

A bivariate analysis was performed to evaluate comparability between the two groups of patients. ADR was compared between groups using bivariate and multivariable logistic regression. Relative difference in ADR vs. AUC, and between the two cohorts, was also calculated.

Of the total population of 3,302 patients, 1,216 patients presented to the teaching facility (there were 6 academic gastroenterologists) and 2,086 presented to the nonteaching facilities (12 community-based gastroenterologists). Patients at the nonteaching facilities were on average 1 year younger, and the endoscopists there were slightly more experienced. All patients in both arms presented for screening, and none had a known history of polyps.

The mean ADR at the teaching site was 28.9%, compared with 25.9% at the nonteaching sites, a small difference that did not reach statistical significance (P = .056). However, when the model was adjusted for differences such as age, sedation, furthest point seen, bowel prep type and quality, experience, and the presence of a fellow, the odds of adenoma detection were 43% higher at the teaching facility, a difference that was highly statistically significant (adjusted odds ratio, 1.43 [1.1-1.8], P = .003).

A plot of the AUC for the teaching site superimposed on the AUC for the nonteaching sites clearly showed that, after detection of the first adenoma at the nonteaching facilities, there was a steep drop-off in the number of cases in which two, three, or four adenomas were detected.

"The difference in AUC between the two sites is largely driven by this difference in the frequency of cases where two, three, and four adenomas are detected per case. We calculated AUC of our teaching facility; it was 56.4 units, compared to 42.7 units at the nonteaching site. This difference was highly statistically significant," (P less than .001), said Dr. Wang. The relative difference in ADR was 10.6%, but the relative AUC difference was 25%.

"As we move toward an era of greater accountability in medicine, our performance measures must become more, and not less, accurate. And I believe the AUC is a step in that direction," said Dr. Wang.

The study was sponsored by an NIH GI Training Grant and CURE: Digestive Diseases Research Center.

CHICAGO – A novel quality indicator called Adenomas Under the Curve might have important advantages over the established metric, the Adenoma Detection Rate, for evaluation of endoscopists’ performance, said Dr. Hank S. Wang at the annual Digestive Disease Week.

The adenoma detection rate (ADR) was developed by the U.S. Multisociety Task Force on Colorectal Cancer and is widely used. However, while it may have strengths, it also has glaring weaknesses – most notably the lack of distinction between detection of one adenoma, and detection of more than one, in a given patient, Dr. Wang said.

"An endoscopist who consistently finds one adenoma per case receives the same credit towards ADR as somebody who consistently finds more than one," said Dr. Wang, a gastroenterology fellow in the division of digestive diseases, University of California, Los Angeles, Training Program.

"Clearly these [two] endoscopists are performing differently, and over a large enough case series, they may even be providing different rates of protection against colorectal cancer. Yet by ADR, they would appear to be identical," he explained.

Use of ADR as a quality measure might actually discourage the search for additional adenomas, said Dr. Wang, or even promote "gaming the quality indicator" to maximize efficiency while still ensuring that credit is received for ADR. Some endoscopists may become less vigilant once they have found the first adenoma, and thus the use of ADR may create a subtle disincentive, he said.

The new metric developed by Dr. Wang and his colleagues, Adenomas Under the Curve (AUC), incorporates ADR data and provides additional quality data on the total number of adenomas detected. Thus AUC extends ADR by capturing data on incremental adenomas beyond the first one detected, said Dr. Wang.

The abstract presented by Dr. Wang compared ADR to AUC in two groups of physicians – academic and community – who were providing screening services for the same pool of patients. Screening colonoscopies were performed over a 4-year period (2005-2009) by two types of practices: a Veterans Affairs teaching hospital endoscopy unit, and a group of three nonteaching, fee-for-service facilities, all serving same population of veterans. The choice of facility was made by the veterans, and the analysis was adjusted for selection bias.

ADR was calculated by dividing the number of cases with one or more adenoma(s) by the total number of cases performed.

In contrast, calculating the AUC involved plotting a histogram showing the frequency of cases and the number of adenomas detected by case. To account for weighting, case frequency was multiplied by the number of adenomas detected per case. When these data were combined, they yielded the measure Adenomas Under the Curve.

A bivariate analysis was performed to evaluate comparability between the two groups of patients. ADR was compared between groups using bivariate and multivariable logistic regression. Relative difference in ADR vs. AUC, and between the two cohorts, was also calculated.

Of the total population of 3,302 patients, 1,216 patients presented to the teaching facility (there were 6 academic gastroenterologists) and 2,086 presented to the nonteaching facilities (12 community-based gastroenterologists). Patients at the nonteaching facilities were on average 1 year younger, and the endoscopists there were slightly more experienced. All patients in both arms presented for screening, and none had a known history of polyps.

The mean ADR at the teaching site was 28.9%, compared with 25.9% at the nonteaching sites, a small difference that did not reach statistical significance (P = .056). However, when the model was adjusted for differences such as age, sedation, furthest point seen, bowel prep type and quality, experience, and the presence of a fellow, the odds of adenoma detection were 43% higher at the teaching facility, a difference that was highly statistically significant (adjusted odds ratio, 1.43 [1.1-1.8], P = .003).

A plot of the AUC for the teaching site superimposed on the AUC for the nonteaching sites clearly showed that, after detection of the first adenoma at the nonteaching facilities, there was a steep drop-off in the number of cases in which two, three, or four adenomas were detected.

"The difference in AUC between the two sites is largely driven by this difference in the frequency of cases where two, three, and four adenomas are detected per case. We calculated AUC of our teaching facility; it was 56.4 units, compared to 42.7 units at the nonteaching site. This difference was highly statistically significant," (P less than .001), said Dr. Wang. The relative difference in ADR was 10.6%, but the relative AUC difference was 25%.

"As we move toward an era of greater accountability in medicine, our performance measures must become more, and not less, accurate. And I believe the AUC is a step in that direction," said Dr. Wang.

The study was sponsored by an NIH GI Training Grant and CURE: Digestive Diseases Research Center.

CHICAGO – A novel quality indicator called Adenomas Under the Curve might have important advantages over the established metric, the Adenoma Detection Rate, for evaluation of endoscopists’ performance, said Dr. Hank S. Wang at the annual Digestive Disease Week.

The adenoma detection rate (ADR) was developed by the U.S. Multisociety Task Force on Colorectal Cancer and is widely used. However, while it may have strengths, it also has glaring weaknesses – most notably the lack of distinction between detection of one adenoma, and detection of more than one, in a given patient, Dr. Wang said.

"An endoscopist who consistently finds one adenoma per case receives the same credit towards ADR as somebody who consistently finds more than one," said Dr. Wang, a gastroenterology fellow in the division of digestive diseases, University of California, Los Angeles, Training Program.

"Clearly these [two] endoscopists are performing differently, and over a large enough case series, they may even be providing different rates of protection against colorectal cancer. Yet by ADR, they would appear to be identical," he explained.

Use of ADR as a quality measure might actually discourage the search for additional adenomas, said Dr. Wang, or even promote "gaming the quality indicator" to maximize efficiency while still ensuring that credit is received for ADR. Some endoscopists may become less vigilant once they have found the first adenoma, and thus the use of ADR may create a subtle disincentive, he said.

The new metric developed by Dr. Wang and his colleagues, Adenomas Under the Curve (AUC), incorporates ADR data and provides additional quality data on the total number of adenomas detected. Thus AUC extends ADR by capturing data on incremental adenomas beyond the first one detected, said Dr. Wang.

The abstract presented by Dr. Wang compared ADR to AUC in two groups of physicians – academic and community – who were providing screening services for the same pool of patients. Screening colonoscopies were performed over a 4-year period (2005-2009) by two types of practices: a Veterans Affairs teaching hospital endoscopy unit, and a group of three nonteaching, fee-for-service facilities, all serving same population of veterans. The choice of facility was made by the veterans, and the analysis was adjusted for selection bias.

ADR was calculated by dividing the number of cases with one or more adenoma(s) by the total number of cases performed.

In contrast, calculating the AUC involved plotting a histogram showing the frequency of cases and the number of adenomas detected by case. To account for weighting, case frequency was multiplied by the number of adenomas detected per case. When these data were combined, they yielded the measure Adenomas Under the Curve.

A bivariate analysis was performed to evaluate comparability between the two groups of patients. ADR was compared between groups using bivariate and multivariable logistic regression. Relative difference in ADR vs. AUC, and between the two cohorts, was also calculated.

Of the total population of 3,302 patients, 1,216 patients presented to the teaching facility (there were 6 academic gastroenterologists) and 2,086 presented to the nonteaching facilities (12 community-based gastroenterologists). Patients at the nonteaching facilities were on average 1 year younger, and the endoscopists there were slightly more experienced. All patients in both arms presented for screening, and none had a known history of polyps.

The mean ADR at the teaching site was 28.9%, compared with 25.9% at the nonteaching sites, a small difference that did not reach statistical significance (P = .056). However, when the model was adjusted for differences such as age, sedation, furthest point seen, bowel prep type and quality, experience, and the presence of a fellow, the odds of adenoma detection were 43% higher at the teaching facility, a difference that was highly statistically significant (adjusted odds ratio, 1.43 [1.1-1.8], P = .003).

A plot of the AUC for the teaching site superimposed on the AUC for the nonteaching sites clearly showed that, after detection of the first adenoma at the nonteaching facilities, there was a steep drop-off in the number of cases in which two, three, or four adenomas were detected.

"The difference in AUC between the two sites is largely driven by this difference in the frequency of cases where two, three, and four adenomas are detected per case. We calculated AUC of our teaching facility; it was 56.4 units, compared to 42.7 units at the nonteaching site. This difference was highly statistically significant," (P less than .001), said Dr. Wang. The relative difference in ADR was 10.6%, but the relative AUC difference was 25%.

"As we move toward an era of greater accountability in medicine, our performance measures must become more, and not less, accurate. And I believe the AUC is a step in that direction," said Dr. Wang.

The study was sponsored by an NIH GI Training Grant and CURE: Digestive Diseases Research Center.

CHICAGO – A novel quality indicator called Adenomas Under the Curve might have important advantages over the established metric, the Adenoma Detection Rate, for evaluation of endoscopists’ performance, said Dr. Hank S. Wang at the annual Digestive Disease Week.

The adenoma detection rate (ADR) was developed by the U.S. Multisociety Task Force on Colorectal Cancer and is widely used. However, while it may have strengths, it also has glaring weaknesses – most notably the lack of distinction between detection of one adenoma, and detection of more than one, in a given patient, Dr. Wang said.

"An endoscopist who consistently finds one adenoma per case receives the same credit towards ADR as somebody who consistently finds more than one," said Dr. Wang, a gastroenterology fellow in the division of digestive diseases, University of California, Los Angeles, Training Program.

"Clearly these [two] endoscopists are performing differently, and over a large enough case series, they may even be providing different rates of protection against colorectal cancer. Yet by ADR, they would appear to be identical," he explained.

Use of ADR as a quality measure might actually discourage the search for additional adenomas, said Dr. Wang, or even promote "gaming the quality indicator" to maximize efficiency while still ensuring that credit is received for ADR. Some endoscopists may become less vigilant once they have found the first adenoma, and thus the use of ADR may create a subtle disincentive, he said.

The new metric developed by Dr. Wang and his colleagues, Adenomas Under the Curve (AUC), incorporates ADR data and provides additional quality data on the total number of adenomas detected. Thus AUC extends ADR by capturing data on incremental adenomas beyond the first one detected, said Dr. Wang.

The abstract presented by Dr. Wang compared ADR to AUC in two groups of physicians – academic and community – who were providing screening services for the same pool of patients. Screening colonoscopies were performed over a 4-year period (2005-2009) by two types of practices: a Veterans Affairs teaching hospital endoscopy unit, and a group of three nonteaching, fee-for-service facilities, all serving same population of veterans. The choice of facility was made by the veterans, and the analysis was adjusted for selection bias.

ADR was calculated by dividing the number of cases with one or more adenoma(s) by the total number of cases performed.

In contrast, calculating the AUC involved plotting a histogram showing the frequency of cases and the number of adenomas detected by case. To account for weighting, case frequency was multiplied by the number of adenomas detected per case. When these data were combined, they yielded the measure Adenomas Under the Curve.

A bivariate analysis was performed to evaluate comparability between the two groups of patients. ADR was compared between groups using bivariate and multivariable logistic regression. Relative difference in ADR vs. AUC, and between the two cohorts, was also calculated.

Of the total population of 3,302 patients, 1,216 patients presented to the teaching facility (there were 6 academic gastroenterologists) and 2,086 presented to the nonteaching facilities (12 community-based gastroenterologists). Patients at the nonteaching facilities were on average 1 year younger, and the endoscopists there were slightly more experienced. All patients in both arms presented for screening, and none had a known history of polyps.

The mean ADR at the teaching site was 28.9%, compared with 25.9% at the nonteaching sites, a small difference that did not reach statistical significance (P = .056). However, when the model was adjusted for differences such as age, sedation, furthest point seen, bowel prep type and quality, experience, and the presence of a fellow, the odds of adenoma detection were 43% higher at the teaching facility, a difference that was highly statistically significant (adjusted odds ratio, 1.43 [1.1-1.8], P = .003).

A plot of the AUC for the teaching site superimposed on the AUC for the nonteaching sites clearly showed that, after detection of the first adenoma at the nonteaching facilities, there was a steep drop-off in the number of cases in which two, three, or four adenomas were detected.

"The difference in AUC between the two sites is largely driven by this difference in the frequency of cases where two, three, and four adenomas are detected per case. We calculated AUC of our teaching facility; it was 56.4 units, compared to 42.7 units at the nonteaching site. This difference was highly statistically significant," (P less than .001), said Dr. Wang. The relative difference in ADR was 10.6%, but the relative AUC difference was 25%.

"As we move toward an era of greater accountability in medicine, our performance measures must become more, and not less, accurate. And I believe the AUC is a step in that direction," said Dr. Wang.

The study was sponsored by an NIH GI Training Grant and CURE: Digestive Diseases Research Center.

CHICAGO – A novel quality indicator called Adenomas Under the Curve might have important advantages over the established metric, the Adenoma Detection Rate, for evaluation of endoscopists’ performance, said Dr. Hank S. Wang at the annual Digestive Disease Week.

The adenoma detection rate (ADR) was developed by the U.S. Multisociety Task Force on Colorectal Cancer and is widely used. However, while it may have strengths, it also has glaring weaknesses – most notably the lack of distinction between detection of one adenoma, and detection of more than one, in a given patient, Dr. Wang said.

"An endoscopist who consistently finds one adenoma per case receives the same credit towards ADR as somebody who consistently finds more than one," said Dr. Wang, a gastroenterology fellow in the division of digestive diseases, University of California, Los Angeles, Training Program.

"Clearly these [two] endoscopists are performing differently, and over a large enough case series, they may even be providing different rates of protection against colorectal cancer. Yet by ADR, they would appear to be identical," he explained.

Use of ADR as a quality measure might actually discourage the search for additional adenomas, said Dr. Wang, or even promote "gaming the quality indicator" to maximize efficiency while still ensuring that credit is received for ADR. Some endoscopists may become less vigilant once they have found the first adenoma, and thus the use of ADR may create a subtle disincentive, he said.

The new metric developed by Dr. Wang and his colleagues, Adenomas Under the Curve (AUC), incorporates ADR data and provides additional quality data on the total number of adenomas detected. Thus AUC extends ADR by capturing data on incremental adenomas beyond the first one detected, said Dr. Wang.

The abstract presented by Dr. Wang compared ADR to AUC in two groups of physicians – academic and community – who were providing screening services for the same pool of patients. Screening colonoscopies were performed over a 4-year period (2005-2009) by two types of practices: a Veterans Affairs teaching hospital endoscopy unit, and a group of three nonteaching, fee-for-service facilities, all serving same population of veterans. The choice of facility was made by the veterans, and the analysis was adjusted for selection bias.

ADR was calculated by dividing the number of cases with one or more adenoma(s) by the total number of cases performed.

In contrast, calculating the AUC involved plotting a histogram showing the frequency of cases and the number of adenomas detected by case. To account for weighting, case frequency was multiplied by the number of adenomas detected per case. When these data were combined, they yielded the measure Adenomas Under the Curve.

A bivariate analysis was performed to evaluate comparability between the two groups of patients. ADR was compared between groups using bivariate and multivariable logistic regression. Relative difference in ADR vs. AUC, and between the two cohorts, was also calculated.

Of the total population of 3,302 patients, 1,216 patients presented to the teaching facility (there were 6 academic gastroenterologists) and 2,086 presented to the nonteaching facilities (12 community-based gastroenterologists). Patients at the nonteaching facilities were on average 1 year younger, and the endoscopists there were slightly more experienced. All patients in both arms presented for screening, and none had a known history of polyps.

The mean ADR at the teaching site was 28.9%, compared with 25.9% at the nonteaching sites, a small difference that did not reach statistical significance (P = .056). However, when the model was adjusted for differences such as age, sedation, furthest point seen, bowel prep type and quality, experience, and the presence of a fellow, the odds of adenoma detection were 43% higher at the teaching facility, a difference that was highly statistically significant (adjusted odds ratio, 1.43 [1.1-1.8], P = .003).

A plot of the AUC for the teaching site superimposed on the AUC for the nonteaching sites clearly showed that, after detection of the first adenoma at the nonteaching facilities, there was a steep drop-off in the number of cases in which two, three, or four adenomas were detected.

"The difference in AUC between the two sites is largely driven by this difference in the frequency of cases where two, three, and four adenomas are detected per case. We calculated AUC of our teaching facility; it was 56.4 units, compared to 42.7 units at the nonteaching site. This difference was highly statistically significant," (P less than .001), said Dr. Wang. The relative difference in ADR was 10.6%, but the relative AUC difference was 25%.

"As we move toward an era of greater accountability in medicine, our performance measures must become more, and not less, accurate. And I believe the AUC is a step in that direction," said Dr. Wang.

The study was sponsored by an NIH GI Training Grant and CURE: Digestive Diseases Research Center.

CHICAGO – A novel quality indicator called Adenomas Under the Curve might have important advantages over the established metric, the Adenoma Detection Rate, for evaluation of endoscopists’ performance, said Dr. Hank S. Wang at the annual Digestive Disease Week.

The adenoma detection rate (ADR) was developed by the U.S. Multisociety Task Force on Colorectal Cancer and is widely used. However, while it may have strengths, it also has glaring weaknesses – most notably the lack of distinction between detection of one adenoma, and detection of more than one, in a given patient, Dr. Wang said.

"An endoscopist who consistently finds one adenoma per case receives the same credit towards ADR as somebody who consistently finds more than one," said Dr. Wang, a gastroenterology fellow in the division of digestive diseases, University of California, Los Angeles, Training Program.

"Clearly these [two] endoscopists are performing differently, and over a large enough case series, they may even be providing different rates of protection against colorectal cancer. Yet by ADR, they would appear to be identical," he explained.

Use of ADR as a quality measure might actually discourage the search for additional adenomas, said Dr. Wang, or even promote "gaming the quality indicator" to maximize efficiency while still ensuring that credit is received for ADR. Some endoscopists may become less vigilant once they have found the first adenoma, and thus the use of ADR may create a subtle disincentive, he said.

The new metric developed by Dr. Wang and his colleagues, Adenomas Under the Curve (AUC), incorporates ADR data and provides additional quality data on the total number of adenomas detected. Thus AUC extends ADR by capturing data on incremental adenomas beyond the first one detected, said Dr. Wang.

The abstract presented by Dr. Wang compared ADR to AUC in two groups of physicians – academic and community – who were providing screening services for the same pool of patients. Screening colonoscopies were performed over a 4-year period (2005-2009) by two types of practices: a Veterans Affairs teaching hospital endoscopy unit, and a group of three nonteaching, fee-for-service facilities, all serving same population of veterans. The choice of facility was made by the veterans, and the analysis was adjusted for selection bias.

ADR was calculated by dividing the number of cases with one or more adenoma(s) by the total number of cases performed.

In contrast, calculating the AUC involved plotting a histogram showing the frequency of cases and the number of adenomas detected by case. To account for weighting, case frequency was multiplied by the number of adenomas detected per case. When these data were combined, they yielded the measure Adenomas Under the Curve.

A bivariate analysis was performed to evaluate comparability between the two groups of patients. ADR was compared between groups using bivariate and multivariable logistic regression. Relative difference in ADR vs. AUC, and between the two cohorts, was also calculated.

Of the total population of 3,302 patients, 1,216 patients presented to the teaching facility (there were 6 academic gastroenterologists) and 2,086 presented to the nonteaching facilities (12 community-based gastroenterologists). Patients at the nonteaching facilities were on average 1 year younger, and the endoscopists there were slightly more experienced. All patients in both arms presented for screening, and none had a known history of polyps.

The mean ADR at the teaching site was 28.9%, compared with 25.9% at the nonteaching sites, a small difference that did not reach statistical significance (P = .056). However, when the model was adjusted for differences such as age, sedation, furthest point seen, bowel prep type and quality, experience, and the presence of a fellow, the odds of adenoma detection were 43% higher at the teaching facility, a difference that was highly statistically significant (adjusted odds ratio, 1.43 [1.1-1.8], P = .003).

A plot of the AUC for the teaching site superimposed on the AUC for the nonteaching sites clearly showed that, after detection of the first adenoma at the nonteaching facilities, there was a steep drop-off in the number of cases in which two, three, or four adenomas were detected.

"The difference in AUC between the two sites is largely driven by this difference in the frequency of cases where two, three, and four adenomas are detected per case. We calculated AUC of our teaching facility; it was 56.4 units, compared to 42.7 units at the nonteaching site. This difference was highly statistically significant," (P less than .001), said Dr. Wang. The relative difference in ADR was 10.6%, but the relative AUC difference was 25%.

"As we move toward an era of greater accountability in medicine, our performance measures must become more, and not less, accurate. And I believe the AUC is a step in that direction," said Dr. Wang.

The study was sponsored by an NIH GI Training Grant and CURE: Digestive Diseases Research Center.

CHICAGO – A novel quality indicator called Adenomas Under the Curve might have important advantages over the established metric, the Adenoma Detection Rate, for evaluation of endoscopists’ performance, said Dr. Hank S. Wang at the annual Digestive Disease Week.

The adenoma detection rate (ADR) was developed by the U.S. Multisociety Task Force on Colorectal Cancer and is widely used. However, while it may have strengths, it also has glaring weaknesses – most notably the lack of distinction between detection of one adenoma, and detection of more than one, in a given patient, Dr. Wang said.

"An endoscopist who consistently finds one adenoma per case receives the same credit towards ADR as somebody who consistently finds more than one," said Dr. Wang, a gastroenterology fellow in the division of digestive diseases, University of California, Los Angeles, Training Program.

"Clearly these [two] endoscopists are performing differently, and over a large enough case series, they may even be providing different rates of protection against colorectal cancer. Yet by ADR, they would appear to be identical," he explained.

Use of ADR as a quality measure might actually discourage the search for additional adenomas, said Dr. Wang, or even promote "gaming the quality indicator" to maximize efficiency while still ensuring that credit is received for ADR. Some endoscopists may become less vigilant once they have found the first adenoma, and thus the use of ADR may create a subtle disincentive, he said.

The new metric developed by Dr. Wang and his colleagues, Adenomas Under the Curve (AUC), incorporates ADR data and provides additional quality data on the total number of adenomas detected. Thus AUC extends ADR by capturing data on incremental adenomas beyond the first one detected, said Dr. Wang.

The abstract presented by Dr. Wang compared ADR to AUC in two groups of physicians – academic and community – who were providing screening services for the same pool of patients. Screening colonoscopies were performed over a 4-year period (2005-2009) by two types of practices: a Veterans Affairs teaching hospital endoscopy unit, and a group of three nonteaching, fee-for-service facilities, all serving same population of veterans. The choice of facility was made by the veterans, and the analysis was adjusted for selection bias.

ADR was calculated by dividing the number of cases with one or more adenoma(s) by the total number of cases performed.

In contrast, calculating the AUC involved plotting a histogram showing the frequency of cases and the number of adenomas detected by case. To account for weighting, case frequency was multiplied by the number of adenomas detected per case. When these data were combined, they yielded the measure Adenomas Under the Curve.

A bivariate analysis was performed to evaluate comparability between the two groups of patients. ADR was compared between groups using bivariate and multivariable logistic regression. Relative difference in ADR vs. AUC, and between the two cohorts, was also calculated.

Of the total population of 3,302 patients, 1,216 patients presented to the teaching facility (there were 6 academic gastroenterologists) and 2,086 presented to the nonteaching facilities (12 community-based gastroenterologists). Patients at the nonteaching facilities were on average 1 year younger, and the endoscopists there were slightly more experienced. All patients in both arms presented for screening, and none had a known history of polyps.

The mean ADR at the teaching site was 28.9%, compared with 25.9% at the nonteaching sites, a small difference that did not reach statistical significance (P = .056). However, when the model was adjusted for differences such as age, sedation, furthest point seen, bowel prep type and quality, experience, and the presence of a fellow, the odds of adenoma detection were 43% higher at the teaching facility, a difference that was highly statistically significant (adjusted odds ratio, 1.43 [1.1-1.8], P = .003).

A plot of the AUC for the teaching site superimposed on the AUC for the nonteaching sites clearly showed that, after detection of the first adenoma at the nonteaching facilities, there was a steep drop-off in the number of cases in which two, three, or four adenomas were detected.

"The difference in AUC between the two sites is largely driven by this difference in the frequency of cases where two, three, and four adenomas are detected per case. We calculated AUC of our teaching facility; it was 56.4 units, compared to 42.7 units at the nonteaching site. This difference was highly statistically significant," (P less than .001), said Dr. Wang. The relative difference in ADR was 10.6%, but the relative AUC difference was 25%.

"As we move toward an era of greater accountability in medicine, our performance measures must become more, and not less, accurate. And I believe the AUC is a step in that direction," said Dr. Wang.

The study was sponsored by an NIH GI Training Grant and CURE: Digestive Diseases Research Center.

CHICAGO – A novel quality indicator called Adenomas Under the Curve might have important advantages over the established metric, the Adenoma Detection Rate, for evaluation of endoscopists’ performance, said Dr. Hank S. Wang at the annual Digestive Disease Week.

The adenoma detection rate (ADR) was developed by the U.S. Multisociety Task Force on Colorectal Cancer and is widely used. However, while it may have strengths, it also has glaring weaknesses – most notably the lack of distinction between detection of one adenoma, and detection of more than one, in a given patient, Dr. Wang said.

"An endoscopist who consistently finds one adenoma per case receives the same credit towards ADR as somebody who consistently finds more than one," said Dr. Wang, a gastroenterology fellow in the division of digestive diseases, University of California, Los Angeles, Training Program.

"Clearly these [two] endoscopists are performing differently, and over a large enough case series, they may even be providing different rates of protection against colorectal cancer. Yet by ADR, they would appear to be identical," he explained.

Use of ADR as a quality measure might actually discourage the search for additional adenomas, said Dr. Wang, or even promote "gaming the quality indicator" to maximize efficiency while still ensuring that credit is received for ADR. Some endoscopists may become less vigilant once they have found the first adenoma, and thus the use of ADR may create a subtle disincentive, he said.

The new metric developed by Dr. Wang and his colleagues, Adenomas Under the Curve (AUC), incorporates ADR data and provides additional quality data on the total number of adenomas detected. Thus AUC extends ADR by capturing data on incremental adenomas beyond the first one detected, said Dr. Wang.

The abstract presented by Dr. Wang compared ADR to AUC in two groups of physicians – academic and community – who were providing screening services for the same pool of patients. Screening colonoscopies were performed over a 4-year period (2005-2009) by two types of practices: a Veterans Affairs teaching hospital endoscopy unit, and a group of three nonteaching, fee-for-service facilities, all serving same population of veterans. The choice of facility was made by the veterans, and the analysis was adjusted for selection bias.

ADR was calculated by dividing the number of cases with one or more adenoma(s) by the total number of cases performed.

In contrast, calculating the AUC involved plotting a histogram showing the frequency of cases and the number of adenomas detected by case. To account for weighting, case frequency was multiplied by the number of adenomas detected per case. When these data were combined, they yielded the measure Adenomas Under the Curve.

A bivariate analysis was performed to evaluate comparability between the two groups of patients. ADR was compared between groups using bivariate and multivariable logistic regression. Relative difference in ADR vs. AUC, and between the two cohorts, was also calculated.

Of the total population of 3,302 patients, 1,216 patients presented to the teaching facility (there were 6 academic gastroenterologists) and 2,086 presented to the nonteaching facilities (12 community-based gastroenterologists). Patients at the nonteaching facilities were on average 1 year younger, and the endoscopists there were slightly more experienced. All patients in both arms presented for screening, and none had a known history of polyps.

The mean ADR at the teaching site was 28.9%, compared with 25.9% at the nonteaching sites, a small difference that did not reach statistical significance (P = .056). However, when the model was adjusted for differences such as age, sedation, furthest point seen, bowel prep type and quality, experience, and the presence of a fellow, the odds of adenoma detection were 43% higher at the teaching facility, a difference that was highly statistically significant (adjusted odds ratio, 1.43 [1.1-1.8], P = .003).

A plot of the AUC for the teaching site superimposed on the AUC for the nonteaching sites clearly showed that, after detection of the first adenoma at the nonteaching facilities, there was a steep drop-off in the number of cases in which two, three, or four adenomas were detected.

"The difference in AUC between the two sites is largely driven by this difference in the frequency of cases where two, three, and four adenomas are detected per case. We calculated AUC of our teaching facility; it was 56.4 units, compared to 42.7 units at the nonteaching site. This difference was highly statistically significant," (P less than .001), said Dr. Wang. The relative difference in ADR was 10.6%, but the relative AUC difference was 25%.

"As we move toward an era of greater accountability in medicine, our performance measures must become more, and not less, accurate. And I believe the AUC is a step in that direction," said Dr. Wang.

The study was sponsored by an NIH GI Training Grant and CURE: Digestive Diseases Research Center.

CHICAGO – A novel quality indicator called Adenomas Under the Curve might have important advantages over the established metric, the Adenoma Detection Rate, for evaluation of endoscopists’ performance, said Dr. Hank S. Wang at the annual Digestive Disease Week.

The adenoma detection rate (ADR) was developed by the U.S. Multisociety Task Force on Colorectal Cancer and is widely used. However, while it may have strengths, it also has glaring weaknesses – most notably the lack of distinction between detection of one adenoma, and detection of more than one, in a given patient, Dr. Wang said.

"An endoscopist who consistently finds one adenoma per case receives the same credit towards ADR as somebody who consistently finds more than one," said Dr. Wang, a gastroenterology fellow in the division of digestive diseases, University of California, Los Angeles, Training Program.

"Clearly these [two] endoscopists are performing differently, and over a large enough case series, they may even be providing different rates of protection against colorectal cancer. Yet by ADR, they would appear to be identical," he explained.

Use of ADR as a quality measure might actually discourage the search for additional adenomas, said Dr. Wang, or even promote "gaming the quality indicator" to maximize efficiency while still ensuring that credit is received for ADR. Some endoscopists may become less vigilant once they have found the first adenoma, and thus the use of ADR may create a subtle disincentive, he said.

The new metric developed by Dr. Wang and his colleagues, Adenomas Under the Curve (AUC), incorporates ADR data and provides additional quality data on the total number of adenomas detected. Thus AUC extends ADR by capturing data on incremental adenomas beyond the first one detected, said Dr. Wang.

The abstract presented by Dr. Wang compared ADR to AUC in two groups of physicians – academic and community – who were providing screening services for the same pool of patients. Screening colonoscopies were performed over a 4-year period (2005-2009) by two types of practices: a Veterans Affairs teaching hospital endoscopy unit, and a group of three nonteaching, fee-for-service facilities, all serving same population of veterans. The choice of facility was made by the veterans, and the analysis was adjusted for selection bias.

ADR was calculated by dividing the number of cases with one or more adenoma(s) by the total number of cases performed.

In contrast, calculating the AUC involved plotting a histogram showing the frequency of cases and the number of adenomas detected by case. To account for weighting, case frequency was multiplied by the number of adenomas detected per case. When these data were combined, they yielded the measure Adenomas Under the Curve.

A bivariate analysis was performed to evaluate comparability between the two groups of patients. ADR was compared between groups using bivariate and multivariable logistic regression. Relative difference in ADR vs. AUC, and between the two cohorts, was also calculated.

Of the total population of 3,302 patients, 1,216 patients presented to the teaching facility (there were 6 academic gastroenterologists) and 2,086 presented to the nonteaching facilities (12 community-based gastroenterologists). Patients at the nonteaching facilities were on average 1 year younger, and the endoscopists there were slightly more experienced. All patients in both arms presented for screening, and none had a known history of polyps.

The mean ADR at the teaching site was 28.9%, compared with 25.9% at the nonteaching sites, a small difference that did not reach statistical significance (P = .056). However, when the model was adjusted for differences such as age, sedation, furthest point seen, bowel prep type and quality, experience, and the presence of a fellow, the odds of adenoma detection were 43% higher at the teaching facility, a difference that was highly statistically significant (adjusted odds ratio, 1.43 [1.1-1.8], P = .003).

A plot of the AUC for the teaching site superimposed on the AUC for the nonteaching sites clearly showed that, after detection of the first adenoma at the nonteaching facilities, there was a steep drop-off in the number of cases in which two, three, or four adenomas were detected.

"The difference in AUC between the two sites is largely driven by this difference in the frequency of cases where two, three, and four adenomas are detected per case. We calculated AUC of our teaching facility; it was 56.4 units, compared to 42.7 units at the nonteaching site. This difference was highly statistically significant," (P less than .001), said Dr. Wang. The relative difference in ADR was 10.6%, but the relative AUC difference was 25%.

"As we move toward an era of greater accountability in medicine, our performance measures must become more, and not less, accurate. And I believe the AUC is a step in that direction," said Dr. Wang.

The study was sponsored by an NIH GI Training Grant and CURE: Digestive Diseases Research Center.

Major Finding: Between July 2002 and December 2008, HT use decreased from 85% to 18% in postmenopausal women over age 60. After adjustment for age and race, women who did not use HT in the previous year had a 55% increased risk of hip fracture. Mean BMD was significantly and inversely associated with cumulative years of HT nonuse.

Data Source: A study of 80,995 patients in the Kaiser Permanente Southern California database.

Disclosures: Dr. Karim said she had no financial conflicts of interest. The study was supported by the University of Southern California.

CHICAGO – Prescriptions for hormone therapy for elderly postmenopausal women declined significantly after the results of the Women's Health Initiative were reported in May 2002, and it now appears that there has been a correspondingly steep rise in hip fracture rates, said Roksana Karim, Ph.D., of the University of Southern California, Los Angeles.

“The rise in hip fracture rates in elderly postmenopausal women may be partially attributed to the continued decline in hormone therapy use,” Dr. Karim said. “Hormone therapy–related benefits on hip fracture do not carry over after cessation.”

This was the conclusion of a longitudinal observational study of 80,995 postmenopausal women aged 60 years or older using data from 11 Kaiser Permanente medical centers in southern California. The study was designed to assess the risk of hip fracture for women who stopped taking hormone therapy (HT), compared with those who continued the therapy. It was also designed to evaluate the risk of hip fracture over time after stopping HT, and to measure bone mineral density (BMD) over time after stopping HT.

Data were collected on hip fracture, HT use, and the use of antiosteoporotic medication from June 2002 through December 2008. All hip fractures were verified by chart review by an orthopedic surgeon who was blinded to patients' HT status. Exclusion criteria included fractures secondary to tumors or high-energy trauma, and periprosthetic fractures. Patients were considered to be HT users if they had filled at least two prescriptions in a given year, as each prescription provides a 3-month supply of medication. HT was defined as estrogen alone or estrogen plus progesterone.

BMD data of the hip and lumbar regions were available for 54,209 women (67%). The 80,955 women had a mean age of 68.8 years and a mean body mass index of 26.9 kg/m

Dr. Karim acknowledged that the study was limited by lack of body mass index data in 47% of the population, or information on history of past HT use or on previous fractures.

The estimated annual cost for osteoporotic fractures in the United States is $18 billion, and hip fractures result in a greater cost and disability than do all other osteoporotic fractures combined. “Women at risk of hip fracture should consider carefully before making a decision of stopping using HT,” she said.

During a question-and-answer session, Andrea LaCroix, Ph.D, professor of epidemiology at the University of Washington, Seattle, said, “It certainly comes as no surprise that women discontinue hormone therapy. There's some loss of bone density and an increase in hip fracture rates. I agree with the conclusion that women coming off hormone therapy should be counseled about their potential for losing bone and having an increased fracture risk, but they've never enjoyed more alternatives for the prevention of hip fracture than they do today, including many agents besides HT.”

'Women at risk of hip fracture should consider carefully before making a decision of stopping using HT.'

Source DR. KARIM

Major Finding: Between July 2002 and December 2008, HT use decreased from 85% to 18% in postmenopausal women over age 60. After adjustment for age and race, women who did not use HT in the previous year had a 55% increased risk of hip fracture. Mean BMD was significantly and inversely associated with cumulative years of HT nonuse.

Data Source: A study of 80,995 patients in the Kaiser Permanente Southern California database.

Disclosures: Dr. Karim said she had no financial conflicts of interest. The study was supported by the University of Southern California.

CHICAGO – Prescriptions for hormone therapy for elderly postmenopausal women declined significantly after the results of the Women's Health Initiative were reported in May 2002, and it now appears that there has been a correspondingly steep rise in hip fracture rates, said Roksana Karim, Ph.D., of the University of Southern California, Los Angeles.

“The rise in hip fracture rates in elderly postmenopausal women may be partially attributed to the continued decline in hormone therapy use,” Dr. Karim said. “Hormone therapy–related benefits on hip fracture do not carry over after cessation.”

This was the conclusion of a longitudinal observational study of 80,995 postmenopausal women aged 60 years or older using data from 11 Kaiser Permanente medical centers in southern California. The study was designed to assess the risk of hip fracture for women who stopped taking hormone therapy (HT), compared with those who continued the therapy. It was also designed to evaluate the risk of hip fracture over time after stopping HT, and to measure bone mineral density (BMD) over time after stopping HT.

Data were collected on hip fracture, HT use, and the use of antiosteoporotic medication from June 2002 through December 2008. All hip fractures were verified by chart review by an orthopedic surgeon who was blinded to patients' HT status. Exclusion criteria included fractures secondary to tumors or high-energy trauma, and periprosthetic fractures. Patients were considered to be HT users if they had filled at least two prescriptions in a given year, as each prescription provides a 3-month supply of medication. HT was defined as estrogen alone or estrogen plus progesterone.

BMD data of the hip and lumbar regions were available for 54,209 women (67%). The 80,955 women had a mean age of 68.8 years and a mean body mass index of 26.9 kg/m

Dr. Karim acknowledged that the study was limited by lack of body mass index data in 47% of the population, or information on history of past HT use or on previous fractures.

The estimated annual cost for osteoporotic fractures in the United States is $18 billion, and hip fractures result in a greater cost and disability than do all other osteoporotic fractures combined. “Women at risk of hip fracture should consider carefully before making a decision of stopping using HT,” she said.

During a question-and-answer session, Andrea LaCroix, Ph.D, professor of epidemiology at the University of Washington, Seattle, said, “It certainly comes as no surprise that women discontinue hormone therapy. There's some loss of bone density and an increase in hip fracture rates. I agree with the conclusion that women coming off hormone therapy should be counseled about their potential for losing bone and having an increased fracture risk, but they've never enjoyed more alternatives for the prevention of hip fracture than they do today, including many agents besides HT.”

'Women at risk of hip fracture should consider carefully before making a decision of stopping using HT.'

Source DR. KARIM

Major Finding: Between July 2002 and December 2008, HT use decreased from 85% to 18% in postmenopausal women over age 60. After adjustment for age and race, women who did not use HT in the previous year had a 55% increased risk of hip fracture. Mean BMD was significantly and inversely associated with cumulative years of HT nonuse.

Data Source: A study of 80,995 patients in the Kaiser Permanente Southern California database.

Disclosures: Dr. Karim said she had no financial conflicts of interest. The study was supported by the University of Southern California.

CHICAGO – Prescriptions for hormone therapy for elderly postmenopausal women declined significantly after the results of the Women's Health Initiative were reported in May 2002, and it now appears that there has been a correspondingly steep rise in hip fracture rates, said Roksana Karim, Ph.D., of the University of Southern California, Los Angeles.

“The rise in hip fracture rates in elderly postmenopausal women may be partially attributed to the continued decline in hormone therapy use,” Dr. Karim said. “Hormone therapy–related benefits on hip fracture do not carry over after cessation.”

This was the conclusion of a longitudinal observational study of 80,995 postmenopausal women aged 60 years or older using data from 11 Kaiser Permanente medical centers in southern California. The study was designed to assess the risk of hip fracture for women who stopped taking hormone therapy (HT), compared with those who continued the therapy. It was also designed to evaluate the risk of hip fracture over time after stopping HT, and to measure bone mineral density (BMD) over time after stopping HT.

Data were collected on hip fracture, HT use, and the use of antiosteoporotic medication from June 2002 through December 2008. All hip fractures were verified by chart review by an orthopedic surgeon who was blinded to patients' HT status. Exclusion criteria included fractures secondary to tumors or high-energy trauma, and periprosthetic fractures. Patients were considered to be HT users if they had filled at least two prescriptions in a given year, as each prescription provides a 3-month supply of medication. HT was defined as estrogen alone or estrogen plus progesterone.

BMD data of the hip and lumbar regions were available for 54,209 women (67%). The 80,955 women had a mean age of 68.8 years and a mean body mass index of 26.9 kg/m

Dr. Karim acknowledged that the study was limited by lack of body mass index data in 47% of the population, or information on history of past HT use or on previous fractures.

The estimated annual cost for osteoporotic fractures in the United States is $18 billion, and hip fractures result in a greater cost and disability than do all other osteoporotic fractures combined. “Women at risk of hip fracture should consider carefully before making a decision of stopping using HT,” she said.

During a question-and-answer session, Andrea LaCroix, Ph.D, professor of epidemiology at the University of Washington, Seattle, said, “It certainly comes as no surprise that women discontinue hormone therapy. There's some loss of bone density and an increase in hip fracture rates. I agree with the conclusion that women coming off hormone therapy should be counseled about their potential for losing bone and having an increased fracture risk, but they've never enjoyed more alternatives for the prevention of hip fracture than they do today, including many agents besides HT.”

'Women at risk of hip fracture should consider carefully before making a decision of stopping using HT.'

Source DR. KARIM