Postcolonoscopy Colorectal Cancer in Sweden From 2003 to 2012: Survival, Tumor Characteristics, and Risk Factors

Forsberg, Anna; Widman, Linnea; Bottai, Matteo; Ekbom, Anders; Hultcrantz, Rolf

doi:10.1016/j.cgh.2020.06.010

Cited by 22 publications

(40 citation statements)

References 23 publications

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“…Although the rates increased with the number of colonoscopies performed, the rates were elevated for IBD patients regardless of the number of colonoscopies performed. This suggests that factors other than increased colonoscopy frequency may explain the high 3-year PCCRC rates among IBD patients and further supports findings from a recently published Swedish study [18].…”

Section: Discussionsupporting

confidence: 89%

“…high PCCRC-3 year rates among IBD patients and further supports findings from a recently published Swedish study [18].…”

Section: Accepted Manuscriptsupporting

confidence: 89%

“…The DNPR also lacks data on colonoscopy surveillance. Earlier studies have consistently reported higher PCCRC occurrence in CRC surveillance populations [11][12][13][14][15]18]. We therefore excluded patients assumed to undergo surveillance in our third sensitivity analysis to elucidate how colonoscopy surveillance affected our results.…”

Section: Discussionmentioning

confidence: 99%

“…Given the high number of colonoscopies performed to detect and monitor IBD, it is possible that the increased IBD-related PCCRC-3 year rate may reflect a high colonoscopy frequency, in turn increasing the likelihood of CRC being categorised as PCCRC. However, evidence remains limited [18].…”

Section: Introductionmentioning

confidence: 99%

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Risk of a post-colonoscopy colorectal cancer diagnosis in patients with inflammatory bowel disease: a population-based cohort study

et al. 2020

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Background and study aims: Post-colonoscopy colorectal cancers (PCCRCs) may account for up to 50% of all colorectal cancers (CRCs) diagnosed in patients with inflammatory bowel disease (IBD). This may reflect a high colonoscopy frequency; however evidence remains limited. Patient and methods: We conducted a cohort study of IBD and non-IBD patients undergoing colonoscopy. We calculated 6-36 months CIPs of PCCRC after first-time and subsequent colonoscopies. We also computed crude and adjusted HRs of PCCRC, comparing IBD with non-IBD patients undergoing first-time and subsequent colonoscopies. Separate analyses were conducted for consecutive colonoscopies. We calculated PCCRC-3 year rates to estimate the proportion of IBD and non-IBD CRC patients experiencing PCCRC. Results: We observed 138 and 1,909 PCCRCs among 34,688 IBD and 358,217 non-IBD patients who underwent colonoscopy. The CIP of PCCRC after first-time colonoscopy was 0.21%, 95% confidence interval (CI): [0.17-0.27] for IBD patients and 0.37%, 95% CI: [0.35-0.39] for non-IBD patients. The adjusted HR of PCCRC after a first-time colonoscopy was 0.96, 95% CI: [0.75-1.22] and the adjusted HRs after subsequent colonoscopies had point estimates around 1.0. The PCCRC-3 year rate was 24.3%, 95% CI: [20.4-28.7] for IBD and 7.5%, 95% CI [7.2-7.8] for non-IBD patients. Conclusions: Although PCCRCs accounted for a substantial proportion of all IBD-related CRCs, IBD patients had a low CIP of PCCRC after colonoscopy. The elevated PCCRC-3 year rates may among other factors stem from increased colonoscopy frequency in IBD patients.

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Section: Discussionsupporting

confidence: 89%

“…high PCCRC-3 year rates among IBD patients and further supports findings from a recently published Swedish study [18].…”

Section: Accepted Manuscriptsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of a post-colonoscopy colorectal cancer diagnosis in patients with inflammatory bowel disease: a population-based cohort study

et al. 2020

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“…Using a population-based cohort from Sweden, Forsberg et al 9 analyzed data on 458,937 colonoscopies (54.0% women patients) performed from 2003 2). Collectively, these results provide the key yet missing data on the process-outcome link for PCCRC rate.…”

Section: Postcolonoscopymentioning

confidence: 99%

Issue Highlights

Kanwal

2020

Clinical Gastroenterology and Hepatology

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C olorectal cancer (CRC) incidence among individuals younger than age 50 is increasing. Recent guidelines recommended lowering the age of screening to 45 years for the general population, but this approach would add substantial cost to the healthcare system and be difficult to implement. 1 Further risk stratification may allow targeted screening to enhance the effectiveness and cost-effectiveness of CRC screening in individuals younger than 50. 2,3 In this issue of Clinical Gastroenterology and Hepatology, Gausman et al 4 compared a range of modifiable and nonmodifiable risk factors in 269 patients with early-onset CRC, 2802 with late-onset CRC, and 1122 age-matched controls. Most early-onset CRCs were sporadic, diagnosed at a late stage, and detected in the left colon or rectum.Male sex, family history of CRC, and personal history of inflammatory bowel disease were the key predictors of early-onset CRC compared with both age-matched controls and late-onset CRC cases. In addition, early-onset CRC patients were more likely to be black or Asian compared with late-onset CRC patients. Socioeconomic factors were not significantly associated with earlyonset CRC.These data show certain nonmodifiable risk factors contribute to early-onset CRC. These factors should be included in risk prediction models to facilitate targeted screening in individuals younger than age 50 while we wait for data on more granular predictors of earlyonset CRC that are measurable and readily available in the clinical setting (Figure 1).

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Mortality After Postcolonoscopy Colorectal Cancer in the Veterans Affairs Health Care System

et al. 2023

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ImportancePostcolonoscopy colorectal cancer (PCCRC) refers to colorectal cancer (CRC) diagnosed after a colonoscopy in which no cancer was found and is reflective of colonoscopy quality at the individual and system levels. Colonoscopy is widely performed in the Veterans Affairs (VA) health care system, but the prevalence of PCCRC and its associated mortality are unknown.ObjectiveTo examine PCCRC prevalence and its all-cause mortality (ACM) and CRC-specific mortality (CSM) within the VA health care system.Design, Setting, and ParticipantsThis retrospective cohort study used VA-Medicare administrative data to identify 29 877 veterans aged 50 to 85 years with newly diagnosed CRC between January 1, 2003, and December 31, 2013. Patients whose colonoscopy occurred less than 6 months before CRC diagnosis with no other colonoscopy within the previous 36 months were categorized as having detected CRC (DCRC). Those who had a colonoscopy that did not detect CRC between 6 and 36 months before CRC diagnosis were categorized as having postcolonoscopy CRC (PCCRC-3y). A third group included patients with CRC and no colonoscopy within the prior 36 months. The final analysis of the data was performed in September 2022.ExposuresPrior receipt of colonoscopy.Main Outcomes and MeasuresCox proportional hazards regression (with censoring, last follow-up December 31, 2018) analyses were conducted to compare PCCRC-3y and DCRC for 5-year ACM and CSM after CRC diagnosis.ResultsOf 29 877 patients with CRC (median [IQR] age, 67 [60-75] years; 29 353 [98%] male; 5284 [18%] Black, 23 971 [80%] White, and 622 [2%] other), 1785 (6%) were classified as having PCCRC-3y and 21 811 (73%) as having DCRC. The 5-year ACM rates were 46% vs 42% for patients with PCCRC-3y vs patients with DCRC. The 5-year CSM rates were 26% vs 25% for patients with PCCRC-3y vs patients with DCRC. In multivariable Cox proportional hazards regression analysis, there was no significant difference in ACM and CSM between patients with PCCRC-3y (adjusted hazard ratio [aHR], 1.04; 95% CI, 0.98-1.11; P = .18) and patients with DCRC (aHR, 1.04; 95% CI, 0.95-1.13; P = .42). However, compared with patients with DCRC, patients with no prior colonoscopy had significantly higher ACM (aHR, 1.76; 95% CI, 1.70-1.82; P &lt; .001) and CSM (aHR, 2.22; 95% CI, 2.12-2.32; P &lt; .001). Compared with patients with DCRC, patients with PCCRC-3y had significantly lower odds of having undergone colonoscopy performed by a gastroenterologist (odds ratio, 0.48; 95% CI, 0.43-0.53; P &lt; .001).Conclusions and RelevanceThis study found that PCCRC-3y constituted 6% of CRCs in the VA system, which is similar to other settings. Compared with patients with CRC detected by colonoscopy, those with PCCRC-3y have comparable ACM and CSM.

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Postcolonoscopy Colorectal Cancer in Sweden From 2003 to 2012: Survival, Tumor Characteristics, and Risk Factors

Cited by 22 publications

References 23 publications

Risk of a post-colonoscopy colorectal cancer diagnosis in patients with inflammatory bowel disease: a population-based cohort study

Risk of a post-colonoscopy colorectal cancer diagnosis in patients with inflammatory bowel disease: a population-based cohort study

Issue Highlights

Mortality After Postcolonoscopy Colorectal Cancer in the Veterans Affairs Health Care System

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