Increased Rate of Adenoma Detection Associates With Reduced Risk of Colorectal Cancer and Death

Abstract

In a prospective study of individuals who underwent screening colonoscopy within a National Colorectal Cancer Screening Program, we associated increased ADR with a reduced risk of interval colorectal cancer and death.

Screening endoscopy for gastric cancer: time for quality control

“…If this holds true, our question now is whether increasing the observation time really helps improve the performance of screening endoscopy. In a recent study on colonoscopy, increased rates of adenoma detection were revealed to be associated with reduced risk of colorectal cancer and mortality (15). It may be hoped that subsequent studies will suggest that prolonged observation time in gastric cancer screening leads to an increase in the detection rate of gastric neoplasms.…”

The proof is in the pudding: improving adenoma detection rates reduces interval colon cancer development

“…Given this discrepancy it is possible that a similar study reproduced in the United States would not produce quite as dramatic results, however, the data demonstrates quite clearly the benefit not only that higher endoscopist ADRs convey to decrease risk of interval CRC but also the effectiveness of regular feedback on ADR. Multiple studies have shown that it is possible to affect ADR by regular feedback and monitoring (9,11,15) and Kaminski's study takes this one, important, step further to show the clinically relevant benefit this feedback has on our patients by decreasing the risk of interval colon cancer and death (13). Still uncertain remains the question of the most effective method to improve ADR: is it written feedback, direct observation by 'high detectors' of their 'low detector' colleagues, innovative technologies to assist in ADR such as alternate-view scopes, supplemental colonoscope attachments, chromoendoscopy, computer aided programs?…”

“…The proof is in the pudding: improving adenoma detection rates reduces interval colon cancer development quintile (ADR >24.5%), the adjusted hazard ratio for interval CRC was 0.27 (95% CI, 0.12-0.63 P=0.003) which translates into a reduction in the rate of interval cancer from 25.3 cases per 100,000 patient-years to 7.1 cases per 100,000 patient-years (13). Interestingly, and notably, the risk for interval CRC appears to be most improved when endoscopists' ADR rose to the highest quintile whereas there is only a negligible effect when ADR improved to/ maintained within the third quintile (ADR 15.1-19.2%).…”

“…The initiation of these quality controls has resulted in an improvement of 1.5% annually in the overall ADR (14). The objective of Kaminski's current study was to assess whether these improvements correlated with a decrease in incidence of interval CRC and mortality from CRC (13). Two hundred and ninety-four endoscopists were divided into 5 quintiles based on their ADR and each endoscopist had an annual ADR calculated which either improved or declined from or maintained their baseline ADR.…”

Adenoma detection rate: the perfect colonoscopy quality measure or is there more?

“…This is further reinforced with the study by Kaminski et al, that showed an increased ADR resulted in an adjusted hazard ratio for interval CRC of 0.63 (95% CI, 0.45-0.88; P=0.006), and for cancer death of 0.50 (95% CI, 0.27-0.95; P=0.035). This is improved versus those that did not have an increase in ADR, with a decreased adjusted hazard ratio for interval CRC of 0.27 (95% CI, 0.12-0.63; P=0.003), and for cancer death of 0.18 (95% CI, 0.06-0.56; P=0.003) (2). Improving techniques to significantly increase your ADRs will improve the care given to your patients.…”