b'Measuring VA Screening Quality By CRC Detected After ColonoscopyVHAs 6% Rate Aligns With Other U.S. Healthcare SystemsColonoscopy might be one of the best tools for detecting colorectal cancer, but that doesnt mean its foolproof. Some cases of CRC are missed, usually because neoplasia are too small to detect. The VHAs 6% rate of post-colonoscopy CRC is in line with other U.S. healthcare systems and is an indicator of a high-quality screening program, according to a new study.By Brenda L. MooneyINDIANAPOLISAlthoughcolonoscopyiscon- aretrospectivecohortstudyusingVA-Medicare sidered a gold standard for the detection and preven- administrative data to identify 29,877 veterans aged tion of colorectal cancer (CRC), some patients are50 to 85 years with newly diagnosed CRC between diagnosed with CRC even when nothing concerningJan. 1, 2003, and Dec. 31, 2013, with final analysis was identified during the screening. in September 2022.Within the VHA, according to a new study, aboutFor purposes of the study, they categorized patients 6% of veterans were diagnosed with CRC after awhosecolonoscopyoccurredlessthan6months colonoscopy that did not diagnose cancer but priorbeforeCRCdiagnosiswithnoothercolonoscopy tothenextguideline-recommendedexamination.within the previous 36 months as having detected TheVAhealthcaresystemdiagnosesabout4,000CRC (DCRC). Those who had a colonoscopy that cases of colon cancer every year among its veterandid not detect CRC between 6 and 36 months before patients. CRCdiagnosiswerecategorizedashavingpost-These post colonoscopy CRCs (PCCRCs) reflectcolonoscopyCRC(PCCRC-3y).Anadditional the quality of the index colonoscopy and are con- group included patients with CRC and no colonos-sidered a barometer of colonoscopy quality at thecopy within the prior 36 months. institutionalandhealthcaresystemlevels,wroteParticipants had a median age of 67, and 98% were researchers from the Richard L. Roudebush VAMC,male. Most, 80%, were white, with 18% Black vet-IndianaUniversitySchoolofMedicineandTheerans and 2% categorized as other. While 6% were RegenstriefInstitute,allinIndianapolis.Mostclassified as having PCCRC-3y, the vast majority, PCCRCsareattributedtomissedorincompletely73%, were considered to have DCRC.resectedcolorectallesions(CRCorprecancerousThe5-yearall-cause-mortalityrateswere46% polyps), whereas fast-growing tumors account for avs. 42% for patients with PCCRC-3y and DCRC, small proportion of PCCRCs. respectively.PatientswithPCCRC-3yhad5-year ThestudyinJAMANetworkOpenalsopointedCSM rates of 26% compared to 25% for patients out that the variability in effectiveness of colonos- with DCRC. copymightbeattributedtooperator-dependentIn multivariable Cox proportional hazards regres-factors, which is critical because these factors aresion analysis, there was no significant difference in potentially remediable with educational and qualityACM and CSM between patients with PCCRC-3y improvement initiatives. 1 (adjusted hazard ratio [aHR], 1.04; 95% CI, 0.98-The study team sought to examine PCCRC preva- 1.11; P = 0.18) and patients with DCRC (aHR, 1.04; lence and its all-cause mortality (ACM) and CRC- 95% CI, 0.95-1.13; P = 0.42), the authors wrote. specificmortality(CSM)withintheVAhealth- However,comparedwithpatientswithDCRC, caresystem.Todothat,researchersconductedpatients with no prior colonoscopy had significantly 109'