A recent study co-authored by AMSURG Medical Director Dr. Jay Popp and researchers at the Icahn School of Medicine at Mount Sinai shows an increase in early-onset colorectal cancer in patients under age 50.
Need a Gastroenterologist? Look Past Average
The U.S. Preventive Services Task Force, an independent panel of primary care and prevention experts, recently issued new guidelines that recommend individuals of average risk begin colorectal cancer (CRC) screenings at age 45 instead of age 50.
The Task Force said its recommendation was prompted by an increase in the CRC rate in younger people. Colorectal cancer is the second leading cause of U.S. cancer death, and more than 10 percent of all new CRC cases are diagnosed in patients under age 50.
While colorectal cancer screenings are essential, clinicians and patients should understand that not all colonoscopies are equal. In particular, to ensure they receive quality care, before scheduling an appointment, patients should ask their gastroenterologist about the gastroenterologist’s adenoma detection rate (ADR) – a measurement that indicates how often precancerous polyps are found during exams and that contributes to how carefully colonoscopies are performed.
A study by the Polish Ministry of Health recently published in the Annals of Internal Medicine separated colonoscopies into high- and low- quality exams, with a 20 percent ADR as the dividing line. The goal for the GI Quality Improvement Consortium (GIQuIC), which sets the standard in the collection and reporting of quality measures for the practice of gastrointestinal endoscopy, is a 25 percent ADR. The study, the first to include baseline examination quality in the analysis of long-term risk for CRC and mortality after a negative colonoscopy, also defined high-quality colonoscopies as those that include cecal intubation (a term that means the entire colon was examined) and adequate bowel preparation.
The Polish researchers found patients who received just one negative colonoscopy were at a lower risk for colorectal cancer for up to 17.4 years – but only if the patient had a high-quality exam. The study concluded colonoscopies with ADRs higher than 20 percent “provided a profound and stable reduction in both CRC incidence and mortality throughout follow-up.” In other words, if the negative screening came from a clinician with an ADR below 20 percent, future CRC risk was higher.
Specifically, the researchers found high-quality exams resulted in a two-fold reduction in the colorectal cancer incidence rate and a two-fold lower mortality rate. With a low-quality colonoscopy, mortality already was significantly higher the first five years after examination. The researchers determined, “Many cases of CRC arise from lesions missed at baseline examination rather than from newly developed lesions.”
An analysis of U.S. patients by Kaiser Permanente in 2014 resulted in similar findings. Specifically, Kaiser found for each one percent increase in ADR, there was a three percent decrease in colorectal cancer risk. That study, published in The New England Journal of Medicine, said the ADR “was inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer.”
The Polish study also concluded high-quality colonoscopies are perhaps even more important for women. “Examination quality particularly affected CRC incidence and mortality in women,” the researchers said. “After low-quality colonoscopy, incidence rates in women were significantly higher than the rates observed in men throughout follow-up.”
In 2019, AMSURG ambulatory surgery centers (ASCs) completed more than 938,000 colonoscopies and identified nearly 360,000 patients with adenomas/cancers. The ADR for AMSURG clinicians participating in GIQuIC is 38.37 percent – nearly double the ADR the Polish study rated as high-quality. (About three-quarters of all AMSURG ASCs participate in GIQuIC.)
“In 2019 AMSURG clinicians identified more than 125,000 additional cancers and adenomas than would be expected if their ADR was simply equal to the national benchmark,” said Dr. Jay Popp, AMSURG Medical Staff Development Lead. “When it comes to colonoscopies, quality can be a life or death matter. By tracking ADR through GIQuIC, our centers provide the information patients need to make informed decisions that will reduce their risk of developing colorectal cancer and will protect their long-term health.”
AMSURG and Mount Sinai Health System Release New Research on Early-Onset Colorectal Cancer
Findings Support Recommendations to Lower Average Screening Age to 45
(NEW YORK, NY & NASHVILLE, TN – May 24, 2021) — AMSURG, a division of Envision Healthcare and a national leader in outpatient care, and Icahn School of Medicine at Mount Sinai, world-renowned for its groundbreaking research, released new findings on colorectal cancer (CRC), which support several recommendations to lower the screening age from 50 to 45 for people who are at average risk for CRC. The findings were presented at the Digestive Disease Week® 2021 virtual scientific meeting on May 23.
The Mount Sinai team analyzed approximately 3 million colonoscopies performed at more than 120 AMSURG ambulatory surgery centers across the country in the last six years. The study specifically looked at de-identified data from patients aged 18 to 54 who received a screening or diagnostic colonoscopy and were not undergoing a colonoscopy to monitor previously detected polyps, cancer, inflammatory bowel disease or genetic conditions predisposing to cancer. Results show:
- Colorectal cancer was detected in 0.58 percent of patients aged 45 to 49 and in 0.53 percent of patients aged 40 to 44
- Polyps that had the greatest possibility of becoming cancerous were found in 7.5 percent of patients aged 45 to 49 and in 5.8 percent of patients aged 40 to 44
- A significant portion of patients had polyps present even if they did not have a documented family history of colorectal cancer
“These findings are significant and can make a meaningful difference in the healthcare system's ability to save patients’ lives. With early and routine colonoscopies, we can prevent polyps from becoming cancerous and even detect and remove cancerous polyps while giving patients a better chance of recovery and survival. These data support efforts to begin screening at age 45 and communicate the importance of on-time screening by early messaging to patients and providers,” said John Popp, MD, Medical Director for AMSURG.
Colorectal cancer is the second leading cause of cancer death in the U.S. and one of the most preventable. The incidence of CRC in patients under 50 has nearly doubled since the early 1990s.[1] Consensus in the medical community is building that patients who are at average risk for CRC should begin screening at age 45.
“This study can inform additional research directed at CRC screening in younger populations. More importantly, it helps physicians inform patients about the importance of early screening several years before they reach screening age; we believe that this will encourage younger patients to get routine screenings on time, at the appropriate age, and with close attention to the individual’s risk factors and symptoms,” said primary investigator, Steven Itzkowitz, MD, Professor of Medicine, Oncological Sciences and Medical Education, and Director of the GI Fellowship Program at Icahn School of Medicine at Mount Sinai.
Risk factors include a family history of CRC or pre-malignant polyps, inflammatory bowel disease and lifestyle habits, such as diet, smoking and obesity. CRC also disproportionately impacts the Black community. While symptoms are not always easy to recognize, they can include a change in bowel habits, such as diarrhea and constipation. Additionally, rectal bleeding, abdominal discomfort or a feeling that the bowel does not completely empty can be a cause for concern. Individuals are urged to listen to their bodies and consult their physicians if they have questions or require medical care.
As a leading provider of colonoscopies, AMSURG submits a larger colonoscopy dataset than any provider to a national endoscopic registry called the GI Quality Improvement Consortium (GIQuIC).
The AMSURG data reviewed for this study was obtained from the registry.
This research on CRC trends in the United States is the first of an ongoing collaboration between AMSURG and Mount Sinai.
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About AMSURG
AMSURG acquires, develops and operates ambulatory surgery centers (ASC) in partnership with physicians throughout the United States. As of January 1, 2021, AMSURG operates and holds ownership in more than 250 ASCs in 34 states and the District of Columbia with medical specialties ranging from gastroenterology to ophthalmology and orthopaedics. To learn more about AMSURG, a division of Envision Healthcare Corporation, visit www.amsurg.com.
About Envision Healthcare Corporation
Envision Healthcare Corporation is a leading national medical group that delivers physician and advanced practice provider services, primarily in the areas of emergency and hospitalist medicine, anesthesiology, radiology/teleradiology, and neonatology to more than 1,800 clinical departments in healthcare facilities in 45 states and the District of Columbia. Post-acute care is delivered through an array of clinical professionals and integrated technologies which, when combined, contribute to efficient and effective population health management strategies.
As a leader in ambulatory surgical care, the medical group operates and holds ownership in more than 250 surgery centers in 34 states and the District of Columbia, with medical specialties ranging from gastroenterology to ophthalmology and orthopaedics. In total, the medical group offers a differentiated suite of clinical solutions on a national scale with a local understanding of our communities, creating value for health systems, payers, providers, and patients. For additional information, visit www.envisionhealth.com.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai is a national and international source of unrivaled education, translational research and discovery, and collaborative clinical leadership ensuring that we deliver the highest quality care—from prevention to treatment of the most serious and complex human diseases. The Health System includes more than 7,200 physicians and features a robust and continually expanding network of multispecialty services, including more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of the Top 20 Best Hospitals in the country and the Icahn School of Medicine as one of the Top 20 Best Medical Schools in country. Mount Sinai Health System hospitals are consistently ranked regionally by specialty by U.S. News & World Report.
For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.
1 Stoffel EM, Murphy CC. Epidemiology and mechanisms of the increasing incidence of colon and rectal cancers in young adults. Gastroenterology. 2020;158(2):341-353.
A closer look at AMSURG CRC prevention, screening efforts — 4 Qs with Dr. Jay Popp
AMSURG, the ambulatory division of Nashville, Tenn.-based Envision Healthcare and a leading colonoscopy provider, made a similar recommendation at the start of this year.
AMSURG Says 200,000 People Missed Their Colonoscopies This Year
“Unlike any other cancer, if you find a polyp, a pre-cancerous growth, during a colonoscopy, you can remove it,” said Dr. John Popp, Medical Director at AMSURG.
AMSURG Reports Nearly 200,000 Patients Have Missed Colonoscopies Since Start of Pandemic
Colonoscopies Are Essential in the Prevention, Early Diagnosis and Treatment of Colorectal Cancer, the Second Leading Cause of Cancer Death
NASHVILLE, Tenn. — AMSURG, a division of Envision Healthcare and a national leader in providing outpatient endoscopic procedures, released new data today on the impact COVID-19 has had on colonoscopies, a vital medical screening test used to detect, prevent and treat colon cancer.
According to AMSURG’s internal data, more than 195,000 patients have missed colonoscopies since the start of the COVID-19 pandemic. AMSURG estimates that its clinicians would have diagnosed more than 850 people with colorectal cancer in those missed cases. Additionally, AMSURG’s analysis found that if this trend continues, it expects to screen almost 32,000 fewer patients for the remainder of 2020 — potentially another 140 undiagnosed cases. The American Cancer Society has estimated there will be approximately 148,000 new cases of colorectal cancer in 2020.
“Based on historical data for this time last year, we would have removed polyps from more than 82,000 patients before they turned cancerous,” said John Popp, MD, Medical Director for AMSURG. “Screening colonoscopies are crucial in detecting, treating and preventing colon cancer, which is the second most common cause of cancer death in the U.S. When diagnosed early, it is often easier to treat, and patients have an increased chance of survival.”
In recent years, more people under the age of 50 have been diagnosed with colon cancer. A colonoscopy is the only screening test that can both detect and prevent colorectal cancer. According to the American Cancer Society, the recommended age to begin screening average-risk people is 45. People at a higher risk include those with a family history of colorectal cancer or pre-malignant polyps, inflammatory bowel disease and certain lifestyle habits. Colon cancer also disproportionately impacts the Black community, which sees higher colon cancer rates and deaths than any other racial or ethnic group.
“As the national leader in the detection and prevention of colon cancer, it is very concerning to see so many patients missing their colonoscopies,” said Jeff Snodgrass, President of AMSURG. “While we all must continue taking precautions to put public health first during the COVID-19 pandemic, people should not delay essential and potentially lifesaving care. AMSURG continues to take all necessary measures to protect the health and safety of our teammates, patients and communities. We have high-quality and safety standards and rigid infection control protocols in place to protect our teams and patients. Our medical facilities remain open for essential care, such as colonoscopies.”
Through its network of ambulatory surgery centers, AMSURG partners with physicians to provide high-quality, same-day outpatient care to patients in communities across the country. AMSURG specializes in gastroenterology, orthopaedic, and ophthalmology and is the leading provider of colonoscopies in the U.S.
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About Envision Healthcare Corporation
Envision Healthcare Corporation is a leading national medical group that delivers physician and advanced practice provider services, primarily in the areas of emergency and hospitalist medicine, anesthesiology, radiology/teleradiology, and neonatology to more than 1,800 clinical departments in healthcare facilities in 45 states and the District of Columbia. Post-acute care is delivered through an array of clinical professionals and integrated technologies which, when combined, contribute to efficient and effective population health management strategies. As a market leader in ambulatory surgical care, the medical group owns and operates 257 surgery centers and one surgical hospital in 34 states and the District of Columbia, with medical specialties ranging from gastroenterology to ophthalmology and orthopedics. In total, the medical group offers a differentiated suite of clinical solutions on a national scale with a local understanding of our communities, creating value for health systems, payers, providers, and patients. For additional information, visit www.envisionhealth.com.
About AMSURG
AMSURG acquires, develops and operates ambulatory surgery centers (ASC) in partnership with physicians throughout the United States. As of January 1, 2020, AMSURG owned and operated 257 ASCs and one surgical hospital in 34 states and the District of Columbia with medical specialties ranging from gastroenterology to ophthalmology and orthopaedics. To learn more about AMSURG, a division of Envision Healthcare Corporation, visit www.amsurg.com.
AMSURG Centers Excel in Patient Experience
Eight Centers Receive the Coveted Press Ganey Guardian of Excellence Award
Surgery centers across the AMSURG network work diligently to deliver an ideal experience and safe, high-quality care to our patients every day. Eight of our centers have consistently exceeded patient experience goals and were awarded the 2020 Press Ganey Guardian of Excellence Award. These surgery centers maintained exemplary patient experience ratings for the past year, ranking within the top fifth percentile of Press Ganey’s eligible clientele. Only 18 of 2,700 surgery centers received the award and AMSURG is honored to represent nearly half of the award recipients.
Guardian of Excellence Award Winners
Gastroenterology
- Endoscopy Center of Southeast, Beaumont, Texas
- Woodlands Endoscopy Center, Texas
- The Endoscopy Center, Knoxville, Tennessee
- Sun City Endoscopy Center, Arizona
Ophthalmology
- The Eye Surgery Center of Paducah, Kentucky
- EyeCare Consultants Surgery Center, Evansville, Indiana
Orthopaedic
- Surgery Center of Volusia, Port Orange, Florida
- Orthopaedic Surgery Center of Ocala, Florida
*This is the second consecutive year for Sun City Endoscopy Center to receive the prestigious award.
“Our surgery centers are an integral part of the healthcare systems in the communities they serve. We commend each of the surgery centers for their commitment to providing exceptional care and experiences for every patient,” said Chan Chuang, M.D., FCCP, FACP, AMSURG President and Envision Healthcare Chief Medical Officer. “These eight centers are shining examples of what it means to provide patient-centered care.”
The Guardian of Excellence Award recognizes healthcare organizations that score in the 95th percentile for patient experience, employee/physician engagement or clinical quality performance. Press Ganey, a leader in development and distribution of patient satisfaction surveys, partners with more than 26,000 organizations to administer the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS). The survey measures the care experiences of patients who receive procedures at Medicare-certified surgery centers.
“AMSURG is very proud of the work these centers perform in service to patients every day. This year has been especially unique, presenting new challenges and working environments,” said Nina Goins, Vice President of Quality and Clinical Services, AMSURG, “The centers have not let these challenges impact the focus on keeping our patients our first priority. They are truly setting the standard.”
AMSURG is proud to recognize these centers and their employees for their ability to uphold and consistently deliver high-quality patient care.
Colonoscopy Aids Patient’s Health Outcome as COVID-19 Crisis Ensues
On Friday, the Florida governor ordered all hospitals and ambulatory surgery centers to cease all elective surgeries due to COVID-19, leaving surgery centers like ours to decide which procedures are considered an emergency. Making these decisions are not easy for our physicians. Each decision is painstaking, having to determine the medical necessity of each procedure on a case-by-case basis.
COVID-19, the new invisible disease, arises in addition to another daily invisible disease – colon cancer. March is Colon Cancer Awareness Month and although this fight is understandably taking a back seat in its importance, it is still a very real killer.
Earlier this week, at Space Coast Endoscopy Center in Rockledge, Florida, a 37-year-old woman began showing somewhat benign symptoms of possible rectal cancer. Feeling that overlooking her symptoms and delaying a colonoscopy could mean dire consequences, our physician performed the procedure. Upon completion, our physician diagnosed her with rectal cancer. If our center were not open to proceed with her procedure, it may have been months before she had her colonoscopy, drastically changing her life story.
Colon Cancer Kills, Too
Colorectal cancer is the second-leading cause of cancer death among men and women combined in the U.S. There will be an estimated 147,950 new cases of colorectal cancer in 2020. 1 in 20 people will be diagnosed with colorectal cancer. 1 in 3 people are not up-to-date with colorectal cancer screening.
Symptoms of colorectal cancer may include
- A persistent change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
- Rectal bleeding or blood in your stool
- Persistent abdominal discomfort, such as cramps, gas or pain
- A feeling that your bowel doesn’t empty completely
- Weakness or fatigue
- Unexplained weight loss
If you believe you are experiencing any of the following symptoms, it’s important for you to schedule an appointment with a gastroenterologist immediately.
How Our Center is Protecting Patients from COVID-19
Our staff continues to be diligent in keeping patients safe during this pandemic. Our center has implemented the following standards:
- Prescreening Patients via the phone and text message
- Screening our staff
- Asking all patient caregivers to wait outside
- Reassessing our patients and taking their temperatures upon entering our facility
- Social distancing our patients in our pre/post procedure area
- Wiping down our facility twice a day or more per the recommended CDC guidelines
- Wearing N-95 masks per recommended NETEC and CDC guidelines
- Waiving up-front payments for procedures unless a patient wants to pay
Yes, procedure numbers are approximately a quarter of our usual caseload, yet we continue to play a vital role in our community as we abide by local/state health department guidelines while readying ourselves to assist however we can. We remain connected with the local police and fire marshal, assuring them of our support as they are truly on the frontlines of this pandemic. We have also reached out to a local nursing home, where one of our staff members works aside from our center, providing an encouraging note and a prepackaged goodie for their patients if their diet permits. In continuing to give, we all feel truly blessed.
GI Nurses: Advocates for Population Hesitant to Care for GI Health
GI Nurses and Associates Week is March 22-28, and AMSURG is proud to recognize the work of GI nurses and associates at partner centers around the country.
Jimmy Dottolo, MSN, RN has served as center leader for the Louisiana Endoscopy Center in Baton Rouge, Louisiana, since 2010. Dottolo manages operations for a staff of more than 80 employees responsible for nearly 33,000 procedures a year.
A former emergency department nurse, Dottolo said his transition to GI nursing and the important role GI nurses play caring for the general population provided an eye-opening education. “GI nurses are advocates; we work with a population that is hesitant to take care of their GI health, so we are constantly working to educate and increase awareness that the GI diseases we see are detectable and preventable.”
GI nurses are vital to the delivery of quality care at AMSURG partner centers. “They are the first wave for patients at our centers; GI nurses prepare patients physically and emotionally for procedures, and it is their passion and knowledge that helps patients through the process,” AMSURG Regional Vice President, Operations Erik Hamnes said.
Passion is a shared trait among GI nurses and associates, many of whom have dedicated their lives to advocating for the necessity of potentially life-saving colorectal cancer screening procedures. Last year alone, AMSURG’s more than 180 endoscopy partner centers performed more than 600,000 colonoscopies.
Robi Rhodes, MSN, RN, is Director of Nursing for MGA GI Diagnostic and Therapeutic Center in Marrero, Louisiana. With three locations in the New Orleans Metropolitan area, MGA and its clinicians are responsible for over 2,000 colonoscopies a month.
Rhodes, who is responsible for overseeing the daily operations of 70 nurses and support staff, said misconceptions regarding digestive health – and the role GI nurses play – persist. “When I tell people that I’m a GI nurse, I still sometimes get that sort of ‘Wow, why did you go into that specialty?’ response,” Rhodes said. “But being a GI nurse, I understand how important the work we do is and how important gastrointestinal health needs to be for our population.”
“A lot of people still don’t understand the reality of things like colorectal cancer, so I’ve been able to use my profession as a conversation starter for discussing GI health with my friends and family,” Rhodes explained.
As a center leader, Rhodes works closely with AMSURG to ensure MGA meets the needs of its community. The operational and strategic support AMSURG provides, Rhodes said, has allowed both he and his clinicians to better focus on their patient population.
“I've talked to directors who operate independent centers, and something I always hear is that the responsibility is all on their shoulders,” Rhodes said. “But having AMSURG as a partner means they’re here to help me – whether it be with day-to-day operations, clinical questions or administrative support, you name it.”
Dr. Edward Esber and a Patient’s Family Promote Colonoscopies in the Battle with Colon Cancer
AMSURG Partner Gastroenterologist, Edward Esber, M.D., FACG, FASGE, and the McCool family recently shared their story of battling colon cancer. Tracy’s husband, John, was diagnosed with stage four colon cancer in the fall of 2018. In hopes of encouraging others to take action now before it’s too late, Tracy is sharing the message of early screening. “Don't put off that colonoscopy… It’s not complicated, it’s a simple procedure and it really does save lives.”
Click here to view the complete video interview.
To learn more about Dr. Esber and the Digestive Health Center in Akron, Ohio, visit dhcakron.com.