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Improved colorectal cancer survival in an army community hospital.

In the later portion of 1988, surgeons at Darnall Army Community Hospital abruptly liberalized the use of colonoscopy in the evaluation of colorectal symptoms. During this period, colonoscopy rates jumped from a median of 31.6 examinations/100,000/year to 217.3 examinations/100,000/year. This study details the changes in outcome from colorectal cancer that followed this change. Before 1989, 74.5% of colorectal cancer patients presented with stage III or IV disease, and median survival was only 25 months. After 1988, the proportion of early cancers (stage 0, I, and II) increased dramatically to 56.4% (p = 0.002). Five-year survival increased concomitantly from 34.0 to 53.5% (p = 0.042). The liberalization of colonoscopy is judged to have had a beneficial effect on the health of the population served by this community hospital.