Adenoma Detection Rate and Risk of Colorectal Cancer and Death

Abstract

BACKGROUND The proportion of screening colonoscopic examinations performed by a physician that detect one or more adenomas (the adenoma detection rate) is a recommended quality measure. However, little is known about the association between this rate and patients’ risks of a subsequent colorectal cancer (interval cancer) and death. METHODS Using data from an integrated health care delivery organization, we evaluated the associations between the adenoma detection rate and the risks of colorectal cancer diagnosed 6 months to 10 years after colonoscopy and of cancer-related death. With the use of Cox regression, our estimates of attributable risk were adjusted for the demographic characteristics of the patients, indications for colonoscopy, and coexisting conditions. RESULTS We evaluated 314,872 colonoscopies performed by 136 gastroenterologists; the adenoma detection rates ranged from 7.4 to 52.5%. During the follow-up period, we identified 712 interval colorectal adenocarcinomas, including 255 advanced-stage cancers, and 147 deaths from interval colorectal cancer. The unadjusted risks of interval cancer according to quintiles of adenoma detection rates, from lowest to highest, were 9.8, 8.6, 8.0, 7.0, and 4.8 cases per 10,000 person-years of follow-up, respectively. Among patients of physicians with adenoma detection rates in the highest quintile, as compared with patients of physicians with detection rates in the lowest quintile, the adjusted hazard ratio for any interval cancer was 0.52 (95% confidence interval [CI], 0.39 to 0.69), for advanced-stage interval cancer, 0.43 (95% CI, 0.29 to 0.64), and for fatal interval cancer, 0.38 (95% CI, 0.22 to 0.65). Each 1.0% increase in the adenoma detection rate was associated with a 3.0% decrease in the risk of cancer (hazard ratio, 0.97; 95% CI, 0.96 to 0.98). CONCLUSIONS The adenoma detection rate was inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer. (Funded by the Kaiser Permanente Community Benefit program and the National Cancer Institute.)

S3-Leitlinie – Kolorektales Karzinom

“…Da das Karzinomrisiko bei Patienten mit CU und einer PSC 5-fach erhöht ist [405] und Karzinome gehäuft rechtsseitig auftreten [404], sollte bei diesen Patienten eine Überwa-chung ab Diagnosestellung unabhängig vom Befall jährlich erfolgen. [413,414].…”

“…35 -39 Monaten die Rate von Intervallkarzinomen nach Koloskopie bei 0,09 % [414] bzw. 0,22 % [413], also ganz erheblich niedriger. Auch scheint in der Hochburg der Intervallkarzinome Kanada die Rate der Intervallkarzinome von 1996 bis 2010 um die Hälfte zurückzugehen (und lag hier dann am Ende bei 0,04 % pro Follow-up-Jahr [434]).…”

Does the “Polyp Paradox” Really Exist?

“…In the discussed study, the ADR of low detectors was *23 %. In comparison with the study published in the New England Journal of Medicine [2], even the low adenoma detectors were highly skilled endoscopists, which might have potentially biased that study. Therefore, future studies evaluating a potential ''polyp paradox'' should also include endoscopists with ADRs \ 20 %.…”

“…Importantly, that study also highlighted the limited effectiveness of colonoscopy in reducing the incidence of proximal (i.e., right sided) colorectal cancer after endoscopic polypectomy. Recently, Corley and co-workers, in another massive study, evaluated the adenoma detection rate (ADR) in relation to the risk of colorectal cancer and death [2]. The ADR, which ranged from 7 to 53 %, was inversely associated with the risk of interval cancer, advanced-stage interval cancer, and fatal cancer, with each 1 % increase in the ADR associated with a 3 % decrease in cancer risk.…”

Intraprocedural Cleansing for Screening Colonoscopy: Avoiding Brownouts

“…Interval cancers are associated with colonoscopists with low ADRs [7]; the desirability of achieving high ADR is emphasized by the observation that a 1 % increase in ADR reduces the overall risk of interval cancer by 3 % and fatal cancers by 5 % [8]. Notably, the conventional recommendation following colonoscopy with poor bowel preparation is a shorter screening or surveillance interval due to potential obscuration of smaller polyps.…”