Battat Anna C, Rouse Robert V, Dempsey Lynne, Safadi Bassem Y, Wren Sherry M
Department of Surgery, Stanford University, G112 PAVAHCS, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
Ann Surg Oncol. 2004 Nov;11(11):970-6. doi: 10.1245/ASO.2004.03.047.
The Veterans Administration hospitals underwent an institutional directive in 1998 to meet a colorectal cancer screening (CRCS) standard. This intervention should result in an increase in the hospital's screening rate and percentage of early-stage rectal cancers diagnosed.
A retrospective review, from 1991 to 2002, of our institution's pathology and cancer registry databases for rectal cancers. CRCS data were obtained from the Veterans Administration Prevention Disease Index. Cancer stage at diagnosis was compared before and after the directive and was compared with the National Cancer Data Base and the Surveillance, Epidemiology, and End Results data.
The rate of CRCS was 55% in 1998 and increased to 75% in 2003. During the 11 years studied, a total of 147 rectal cancers were diagnosed. After the Veterans Administration directive, there was a significant increase in stage 0 cancers (P < .02) and an overall migration to earlier-stage cancers. Our Veterans Administration hospital had a significantly greater percentage of stage 0 cancers both before (P < .007) and after the directive (P < .00) and had fewer stage 3 cancers after the directive (P < .03) compared with National Cancer Data Base data. Compared with Surveillance, Epidemiology, and End Results data, the Palo Alto Veterans Affairs Health Care System had more local disease (P < .03) and less regional disease (P < .006).
These data suggest that a monitored institutional directive may significantly increase early detection of rectal cancers. This should result in a greater survival rate and lower local recurrence rate, because survival is predicated on stage at presentation. This may serve as a model for other health-care systems.
退伍军人管理局医院在1998年接受了一项机构指令，以达到结直肠癌筛查（CRCS）标准。这项干预措施应能提高医院的筛查率以及早期直肠癌的诊断百分比。
对1991年至2002年我们机构的直肠癌病理和癌症登记数据库进行回顾性研究。CRCS数据来自退伍军人管理局预防疾病指数。比较指令前后的诊断癌症分期，并与国家癌症数据库以及监测、流行病学和最终结果数据进行比较。
1998年CRCS率为55%，2003年增至75%。在研究的11年中，共诊断出147例直肠癌。退伍军人管理局指令发布后，0期癌症显著增加（P < .02），且总体上向早期癌症转变。与国家癌症数据库数据相比，我们的退伍军人管理局医院在指令发布前（P < .007）和发布后（P < .00）0期癌症的百分比都显著更高，指令发布后3期癌症更少（P < .03）。与监测、流行病学和最终结果数据相比，帕洛阿尔托退伍军人事务医疗保健系统的局部疾病更多（P < .03），区域疾病更少（P < .006）。
这些数据表明，一项受监测的机构指令可能显著提高直肠癌的早期检测率。这应会带来更高的生存率和更低的局部复发率，因为生存率取决于就诊时的分期。这可能为其他医疗保健系统提供一个模式。
