Why so many?

John Inadomi, M.D., a professor at the University of Washington School of Medicine and chair of the American Gastroenterological Association's clinical practice and quality management committee, cites a number of factors that may lead doctors to perform more colonoscopies than necessary.

Some physicians may simply disagree with the recommended intervals, although they are based on substantial research. Others, recognizing the difficulty in performing a visual examination of the colon, worry that they may overlook a polyp and figure that more frequent examinations provide a greater margin of safety.

"I think a lot of us look for reasons to bring back people early, because we know we miss things," Inadomi says.

Meanwhile, financial incentives may be at work, Inadomi adds.

As is the case with other physicians, gastroenterologists are paid for how many procedures they perform, not based on whether their patients have a healthy outcome.

"We get paid for doing more," he says. "There is an inherent conflict here."

As part of the Choosing Wisely campaign with Consumer Reports and the American Board of Internal Medicine Foundation, Inadomi's committee is working to reduce the overuse of colonoscopies by recommending the procedure once every 10 years for patients at average risk, and by discouraging screening within less than three years if polyps have been found and completely removed.

"We recognize that overuse occurs and we want to own this problem ourselves," he says.

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