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Prevention and Early Detection of Colorectal Cancer: A Decision Support Tool

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Prevention and Early Detection of Colorectal Cancer: A Decision Support Tool

Related to: Claims, Clinical Guidelines, Diagnosis, Primary Care, Other Specialties

Colorectal cancer is the second leading cause of cancer-related death in the United States. It is also among the most common types of cancer cited in diagnosis-related malpractice claims naming CRICO-insured physicians. Common causal factors underlying missed or delayed colorectal cancer diagnoses include:

  • a physician—often due to a narrow diagnostic focus—fails to order diagnostic testing or provide ongoing monitoring of a patient who exhibits worrisome symptoms, including rectal bleeding, or for signs such as unexplained iron deficiency anemia
  • a physician whose practice fails to track compliance with and results from ordered screening tests—including stool cards, flexible sigmoidoscopies, and colonoscopies
  • a primary care provider fails to follow routine cancer screening guidelines for colorectal cancer

To address these risk issues, CRICO convened a task force of primary care providers and gastroenterologists to develop a colorectal cancer decision support tool to help clinicians:

  1. Assess patients for colorectal cancer risk factors, particularly family history.
  2. Stratify a patient’s risk for colon cancer into one of three groups:
    • Average Risk Patients who are asymptomatic, over age 50, with no personal or family history of colorectal cancer or adenomas
    • Moderate Risk Patients who have a family1 or personal history of colorectal cancer or adenomas
    • High Risk Patients who have a genetic colorectal cancer syndrome2–5 or inflammatory bowel disease.6–9
  3. Offer appropriate screening modalities according to patient risk and patient preference.10–13
  4. Identify the advantages and disadvantages of each selected screening modality.10–13

Prevention and Early Detection of Colorectal Cancer is based on national colorectal cancer screening and clinical practice guidelines11–19 and is a decision-support tool which should not be construed as a standard of care.


March 4, 2014
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