Thread by @UCSFDOM

1/ Starting now #UCSFMGR with @UCSFGIfellows @kpthrive Dr. Doug Corley on Updates on Colorectal Cancer Screening, esp w/ the latest controversial @NEJM NordICC trial: nejm.org/doi/full/10.10…

Dr. @Bob_Wachter opens w/ humorous Dave Barry quote re:colo: miamiherald.com/living/liv-col…

@UCSFGIfellows @kpthrive @NEJM @Bob_Wachter 2/ Dr. @DouglasCorley notes that there are many CRC deaths even w/ effective CRC screening - it's the 2nd leading cause of cancer death. Current screening modalities have different types of supporting evidence: FOBT, FIT test, septin-9 blood testing, sigmoidoscopy & colonoscopy.

@UCSFGIfellows @kpthrive @NEJM @Bob_Wachter @DouglasCorley 3/ Digging into NordICC Methods: this was really an EFFECTIVENESS trial of INVITATION to a real-world implementation program. CRC screening is not only diagnostic, but also preventative & long lag time b/w dx & mortality. The study showed moderate uptake of colo - like US.

@UCSFGIfellows @kpthrive @NEJM @Bob_Wachter @DouglasCorley 4/ Lots of nuances to the study & important to contextualize in US. Dr. @DouglasCorley research in @JAMA_current & @NEJM (nejm.org/doi/full/10.10…) showing efficacy of both FOBT & FIT & increased screening associated w/ marked reductions in CRC incidence, mortality & disparities!

@UCSFGIfellows @kpthrive @NEJM @Bob_Wachter @DouglasCorley @JAMA_current 5/ No RCTs directly comparing modalities but modeling studies from USPTSF clearly shows benefit >> risk for screening (jamanetwork.com/journals/jama/…). Ppl die more frm not having been screened at all rather than ineffective screening, & higher-risk adenomas are assoc w/ more Ca risk

@UCSFGIfellows @kpthrive @NEJM @Bob_Wachter @DouglasCorley @JAMA_current 6/ Can we better characterize/predict which adenomas are 'high-risk'?

Last Q-does colo operator matter? YES-strong association w/ adenoma detection rate by MD & post-polyp risk in @JAMA_current study by Dr. @DouglasCorley: jamanetwork.com/journals/jama/… More time is not better always.

@UCSFGIfellows @kpthrive @NEJM @Bob_Wachter @DouglasCorley @JAMA_current 7/ Training & quality feedback can decrease variation & improve outcomes in upcoming study by Dr. @DouglasCorley looking at online training kp.org/dare under GI specialty network. Ongoing trials of #MedEd & #QI that show this benefit of training & feedback.

@UCSFGIfellows @kpthrive @NEJM @Bob_Wachter @DouglasCorley @JAMA_current 8/ Bottom-line: Does screening work? YES & closes disparities. Which test is best? "The one that gets done!" Colo operator does matter.

Fascinating talk & Q&A w Dr @Bob_Wachter - will post YouTube link soon.

Next week's #UCSFMGR: Updates in Hospital Med w/ The Brads @UCSFDHM