To recognize March as Colorectal Cancer Awareness Month, events held across the U.S. this past month have drawn attention to the importance of being screened, but also to the value of high-quality screening.  During my participation in the Prevent Cancer Foundation’s Dialog for Action® conference, I learned that not all screenings are created equally.

For those undergoing the gold standard colonoscopy screenings, there are several important patient responsibilities. First and foremost, it is vital to adhere carefully to prep directions.  Having quality bowel prep is essential to the effectiveness of screening and poor bowel prep is a major impediment to the effectiveness of colonoscopy.   Inadequate bowel prep can lead to a need for premature termination of the examination prior to full cecal intubation.
              

Cecal intubation is defined as passage of the colonoscope tip to a point proximal to the ileocecal valve so that the entire cecal caput, including the medial wall of the cecum between the ileocecal valve and appendiceal orifice, is visible (ASGE definition). The need for cecal intubation is based on the persistent finding that a substantial fraction of colorectal neoplasms are located in the proximal colon, including the cecum. Visualization of this area is paramount to the prevention of colon cancer, so it’s commonly accepted that doctors should strive for 90% or higher cecal intubation. 

The National Colorectal Cancer Roundtable is working on an initiative to create an accreditation program that would take into consideration quality measures such as cecal intubation, adenoma detection rate and withdrawal time. The accreditation would serve as a report card that provides clarification to patients and referring physicians as to which doctors and facilities are truly providing quality colonoscopies.

                Another consideration while planning for a colonoscopy is to ask your doctor the type of sedation he or she offers and who will be administering the drug.  Recent studies indicate there are many merits to receiving propofol administered by an anesthesiologist or a certified registered nurse anesthetist.  There is less clinical multi-tasking and more of the gastroenterologist’s attention being paid to the colonoscopy.

Make sure you make the most of the screening by receiving quality care, adhering to prep instructions and ask to be sedated with propofol so you improve your polyp detection rate and bounce back quickly.