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Am Fam Physician. 2022;106(2):online

Clinical Question

What proportion of screening colonoscopies for cancer are not performed according to guideline parameters?

Bottom Line

About 17% to 25.7% of screening colonoscopies are performed too frequently or in patients who are too young or too old. In the United States, this rate translates into approximately 1 million colonoscopies performed each year outside of the parameters set by guidelines. Screening via colonoscopy for colon cancer has never been shown to reduce overall mortality. (Level of Evidence = 1a−)


The researchers searched two databases for English-language studies of screening colonoscopies for average-risk patients, identifying six studies with 242,756 screening colonoscopies. The studies defined colonoscopy overuse according to criteria from the U.S. Preventive Services Task Force and the U.S. Multi-Society Task Force on Colorectal Cancer; that is, colonoscopy conducted in patients younger or older than the age range specified in national guidelines or at shorter intervals than recommended. The researchers followed PRISMA guidelines: two researchers selected articles for inclusion and two researchers independently abstracted data. These were all database studies. The studies reported one in four to one in six (17% to 25.7%) colonoscopies to be out of compliance with national guidelines.

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POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see Copyright Wiley-Blackwell. Used with permission.

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