DNA Stool Testing VS Colonoscopy

Most of you know of the colorectal cancer (CRC) screening test that you can do at home and mail in. This test is called Cologuard and is a two part test; it looks for DNA mutations and microscopic traces of blood in your stool, also called a FIT. There has been a great push to utilize this test in the last few years as it is less invasive and no need to take time off of work to complete.

An article A practical Overview of the Stool DNA Test for Colorectal Cancer Screening published by the American College of Gastroenterology, 2022, discussed the findings of the characteristics for the DNA/FIT test vs FIT testing alone as compared to colonoscopy. This pivotal study looked at 9,989 average-risk individuals’ ages 50-84 that completed the DNA/FIT test, FIT test alone, and a follow up colonoscopy. The results show that the DNA/FIT test detects 92.3% of CRC vs FIT alone which detects 73.8%. It also finds that 42% of polyps 10 mm or greater. So Cologuard miss rate or false negative rate is 8% for colon cancer and 58% of polyps 1 cm or greater; not only can it miss cancer that has already developed but it is not effective in detecting pre-cancerous polyps. This same study found false positive rate of 13%, for most of these patients they will have a worry that they have colon cancer until the colonoscopy can be done. In an area that does not have access to quality colonoscopy the Cologuard study maybe appropriate, if the patient understand the miss rate of this test. However in the North Country high quality colonoscopy is available and should be the first choice.

North Country Gastroenterology Executive Summary 2024

“Five studies have established that gastroenterologists are more effective than surgeons and primary care physicians at preventing colorectal cancer by colonoscopy (CRC).” I According Corley published in the New England Journal of Medicine, there is a 3 percent reduction in colorectal cancer incidence and a 5 percent reduction in cancer mortality for each 1 percent increase in adenoma detection rate II.

·        Colonoscopy is the most effective procedure for finding adenomatous polyps if the adenoma detection rate is high enough; according to the studies adenomas should be detected at least 25% of the time.

  In 2024 we have had an adenoma detection rate of 57%. For the last 10 years our adenoma detection rate is 51%.     

·        According to the recent studies, inadequate preparation should not occur in more than 15% of colonoscopies. 

  Patients at North Country Gastroenterology (NCG) have an inadequate prep rate of only 5%.

·        Cecal intubation should happen in at least 90% of colonoscopies and photographic documentation in 95%.

  At NCG we reach Cecal intubation in 99.2% of colonoscopies and every patient goes home with photographs that are labeled with the findings.

·        Perforation should occur in less than 1/1000 for screening procedures and 1/500 for all other exams.

  Out of a total of 17,027 cases, we have only had 2 perforations; both with polyp removal and none for screening or surveillance purposes.

·        Withdrawal time of the colonoscopy should be greater than or equal to 6 mins.

  100% of completed colonoscopies done at NCG take greater than 6 minutes to withdraw. The average withdrawal time at NCG is 12 minutes.

·        Sessile polyps less than 2 cm should be removed endoscopically in more than 90% of cases.

  100% of those polyps have been removed at the time of endoscopy here at NCG.

·        A second look in the colon via forward view or retroflex view should be done in the majority of screening cases, as this can increase adenoma detection rates thus decreasing colorectal cancer.

  100% of colonoscopies performed include a second look at the ascending colon and cecum.

I. Rex, Douglas K. MD, etal: Quality Indicators for Colonoscopy. The American Journal of Gastroenterology, 110: 72-90. Doi 10.1038/ajg.2014.385

II. Corley, Douglas A. MD, PHD etal: Adenoma Detection Rate and Risk of Colorectal Cancer and Death. The New England Journal of Medicine.   DOI: 10.1056/NEJMoa1309086

North Country Gastroenterology Executive Summary 2022

The North Country Gastroenterology Experience 2022

“Five studies have established that gastroenterologists are more effective than surgeons and primary care physicians at preventing colorectal cancer by colonoscopy (CRC).” I According Corley published in the New England Journal of Medicine, there is a 3 percent reduction in colorectal cancer incidence and a 5 percent reduction in cancer mortality for each 1 percent increase in adenoma detection rate.

• Colonoscopy is the most effective procedure for finding adenomatous polyps if the adenoma detection rate is high enough; according to the studies adenomas should be detected at least 25% of the time.

  •   In 2022 we have had an adenoma detection rate of 57%. For the last 9 years our adenoma detection rate is 48%.     

  • North Country Gastroenterology participates in a Nation Wide registry, in comparison NCG adenoma detection rate is 9.5% higher than the Nation Wide registry.

• According to the recent studies, inadequate preparation should not occur in more than 15% of colonoscopies. 

  • Patients at North Country Gastroenterology (NCG) have an inadequate prep rate of only 4.3%.

• Cecal intubation should happen in at least 90% of colonoscopies and photographic documentation in 95%.

  • At NCG we reach cecal intubation in 100% of colonoscopies and every patient goes home with photographs of our findings.

• Perforation should occur in less than 1/1000 for screening procedures and 1/500 for all other exams.

  • Out of a total of 16,149 cases, we have only had 2 perforations; both with polyp removal and none for screening purposes.

• Withdrawal time of the colonoscopy should be greater than or equal to 6 mins.

  • 100% of completed colonoscopies done at NCG take greater than 6 minutes to withdraw. The average withdrawal time at NCG is more than 10 minutes.

• Sessile polyps less than 2 cm should be removed endoscopically in more than 90% of cases.

  • 100% of those polyps have been removed at the time of endoscopy here at NCG.

• A second look in the colon via forward view or retroflex view should be done in the majority of screening cases, as this can increase adenoma detection rates thus decreasing colorectal cancer.

  • 100% of colonoscopies performed include a second look at the ascending colon and cecum.

I. Rex, Douglas K. MD, Schoenfeld, Philip S. MD, MSEd, MSc (Epi), Cohen, Jonathan MD, Pike, Irving M. MD, Adler, Douglas G. MD, Fennerty, M. Brian MD, Lieb II, John G. MD, Park, Walter G. MD, Rizk, Maged K. MD, Sawhney, Mandeep S. MD, MS, Shaheen, Nicholas J. MD, MPH, Wani, Sachin MD, and Weinberg, David S. MD, MSc. (2014). Quality Indicators for Colonoscopy. The American Journal of Gastroenterology, 110: 72-90. Doi 10.1038/ajg.2014.385

NCG and COVID-19

North Country Gastroenterology is still accepting new patients at this time; we are also trying to maintain our excellent patient care by continuing with regular follow ups and diagnostic procedures. If you or your providers have any questions please feel free to call 603-444-0272 and use ext 19 to speak with our office manager.

During this COVID-19 pandemic Dr. Mitz is also offering tele-health calls when appropriate. This will allow our patients to still have appropriate follow up appointments while maintaining social distancing and staying healthy. Dr. Mitz is offering these appointments on a case by case basis. If you are interested please call the office at 444-0272 and let us know you are interested. Dr. Mitz will be utilizing the application called Skype to video chat with patients. 

If you need a screening colonoscopy or upper endoscopy we can do all the preliminary work on the phone and via the mail. However we will be waiting until the COVID -19 pandemic has subsided before we schedule screening procedures. 

To learn more about COVID-19 please use this link to see the newest information directly from the Center of Disease Control https://www.cdc.gov/coronavirus/2019-ncov/index.html

1st Annual Blue Hair Day

Come join North Country Gastroenterology for the first annual blue hair day!

Dr. Howard Mitz is teaming up with Mane Street Styles owner Deanna, to offer hair extensions to the public to raise awareness for colon cancer. North Country Gastroenterology will donate to the American Cancer Society by paying for the cost of the blue hair for all participants that come to North Country Gastroenterology to participate.

Come to North County Gastroenterology, located at 220 Cottage Street in Littleton on March 3 from 11:30 a.m. to 1:30 p.m. to participate, no appointment needed. We will also be offering light refreshments; participants may donate to the American Cancer Society if they wish.

March is colon cancer awareness month and this year Dr. Mitz and his staff want to help bring more attention to fighting colon cancer. Colon cancer is the second leading cancer related death in America right now. It is preventable with timely colonoscopies and follow up surveillance. Please join us at 220 Cottage street Littleton NH on March 3rd and help us to spread awareness for colon cancer!

For the remainder of the month Mane Street Styles will continue to offer the blue hair extensions for a 10 dollar donation towards the American Cancer Society, no appointment needed!