Endoscopy center's assembly-line style has many patients worried

News that an eighth case of acute hepatitis C has been linked to the Endoscopy Center of Southern Nevada is sure to make the community shudder.

With more than 40,000 patients of the center potentially affected by its substandard medical care, the alarm over the potential spread of disease because of the reuse of anesthesia vials and other shoddy practices - no matter how remote - appears more justified with the identification of each new acute case.

But there's another element to this story that readers remind me hasn't received sufficient amplification: the image of the endoscopy center as a glorified factory.

Under pressure from management to accomplish as many procedures as possible in the shortest amount of time, numerous sources have reported standard medical practices occasionally fell by the wayside. But for weeks readers have asked me, "What about the quality of the actual procedures themselves?"

It's what the physicians and nurses might have missed in their haste that keeps some people up at night.

Of the many calls I've received on this issue, patient concern over the rapid, assembly-line style of the clinic ranks up with the possibility of contracting hepatitis C and HIV, the virus that causes AIDS.

Endoscopes aren't magic wands. They're tools of early detection in the fight against colorectal diseases and colon cancer. But endoscopes don't catch polyps and pre-cancerous conditions.

Doctors do.

A recent study found that it's the quality of the exam that can make the difference between early detection and an uncomfortable and dangerous exercise in futility.

It turns out not all polyps are created equal and don't present themselves in the same way. While some look like a turkey waddle, others are flat and difficult to detect.

The quality of the exam is everything.

The American Cancer Society has new guidelines on tests for colon cancer (the third most common form of the disease) and recommends tests capable of finding polyps along with cancer.

Here's why early detection, and the professional quality of the exam, is so important. According to the ACS, colon cancer has a 92 percent cure rate when detected early in stage I. That percentage drops to 8 percent if the disease has spread to stage IV.

Here's the challenge: Colon cancer shows few signs in its early stages. A professionally performed colonoscopy is essential to the prevention process.

Invasive examination, of which the colonoscopy is the most common, remains the medical standard, but technology is changing.

The "virtual colonoscopy," in which a patient's colon is studied with the use of a CT scan, is now on the ACS list of effective testing options.

Of course, the tests must be conducted professionally with results that are examined thoroughly.

Unlike so many other cancers, colon cancer can be avoided if precancerous polyps are removed before turning into cancer.

"Prevention is the priority as opposed to just detecting cancer," ACS director of screening Robert Smith recently told the Seattle Times.

The good news is that survival rates continue to improve. Although the ACS estimates that nearly 50,000 people will die from colon cancer in 2008, with more than 108,000 newly diagnosed cases expected, there are more than 1 million survivors.

In Nevada, the Nevada Cancer Institute and the ACS estimate 1,160 people will be diagnosed with colon cancer and 490 will die.

The survival rate continues to increase in no small part because more people are being tested, ACS cancer experts say.

According to the Centers for Disease Control and Prevention, 60.8 percent of adults have been screened and tested for the disease.

(That number is somewhat deceiving because it includes those who have had a fecal occult blood test, which checks only for blood in the stool and doesn't detect polyps.)

But does anyone who has watched the endoscopy center scandal unfold honestly believe testing for the disease is going to rise locally now that these substandard practices have been exposed?

That's potentially the greatest tragedy of all associated with this debacle: The community's loss of confidence in the belief that locals can receive reliable, life-saving medical procedures close to home.

There's the greatest irony of all.

Now that the endoscopy center crisis has been uncovered and addressed, and local physicians are under unprecedented scrutiny, there's no better time to be tested.

• John L. Smith's column, reprinted from the Las Vegas Review-Journal, appears on Thursdays on the Appeal's Opinion page. E-mail him at smith@reviewjournal.com or call (702) 383-0295.


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