Annals of Internal Medicine tip sheet for March 5, 2013

A special supplement on patient safety strategies will be published with the March 5 issue. In addition to the 10 articles included in the supplement, Annals of Internal Medicine also will publish a special five-page graphic narrative on the topic of medical errors. Please see summaries at the bottom of the page for information. Full text of the graphic novel and articles in the supplement are available upon request.

1. Screening with Colonoscopy May Reduce Risk for Late-stage Cancer By 70 Percent

Screening with sigmoidoscopy yields similar results in cancer of the left colon, but not the right

Using colonoscopy to screen average-risk adults for colorectal cancer (CRC) reduces the risk for diagnosis of late-stage CRC by about 70 percent for both the right- and left-sided disease. Previous trials and observational studies have shown that screening with fecal occult blood tests (FOBT) and sigmoidoscopy reduce the risk for CRC incidence and death, but evidence of the effectiveness of screening colonoscopy has been limited. Researchers reviewed health records for 1,012 average-risk adults between the ages of 55 and 85 to examine the association between screening colonoscopy and incident late-state CRC risk. Case patients (n = 474), or those with advanced CRC at the time of diagnosis, were compared to 538 control patients. Those screened with colonoscopy had a significant overall reduction in the risk for late-stage colorectal cancer diagnosis. The authors simultaneously examined the association between screening sigmoidoscopy and late-state CRC risk. They found that screening sigmoidoscopy was associated with a reduction in risk similar to that of colonoscopy for left-sided late-stage CRC, but showed a modest, statistically nonsignificant effect on risk for right-sided colon cancer, which accounts for about 50 percent of new CRC cases in the United States. A link to this article will be live at 5:00 p.m. on March 4 http://www.annals.org/article.aspx?doi=10.7326/0003-4819-158-5-201303050-00001.

Note: For an embargoed PDF, please contact Megan Hanks or Angela Collom. To speak with the author, please contact Katie Delach at 215-349-5964 or katie.delach@uphs.upenn.edu.

2. Mailings Linked to Electronic Health Records Double Colorectal Cancer Screening Adherence Rates

Sending automated mailings linked to electronic health records (EHR) led to twice as many persons adhering to colorectal cancer (CRC) screening recommendations compared to usual care. CRC is the second leading cause of cancer death in the United States. Screening has been proven to reduce morbidity and mortality, but fewer than 60 percent of Americans aged 50