Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice

Rex, Douglas K.; Rahmani, Emad; Haseman, Joseph H.; Lemmel, Gregory T.; Kaster, Steven; Buckley, Joseph S.

doi:10.1016/s0016-5085(97)70213-0

Cited by 530 publications

(245 citation statements)

References 5 publications

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“…Sensitivity of the initial and surveillance colonoscopic examinations is based on tandem studies of colonoscopy and increases from 80% for adenomas Յ 5 mm to 95% for preclinical cancer. [23][24][25] The simulated population of 5 independent simulations of 30,000 each (5 ϫ 30,000 ϭ 150,000) was designed to be approximately 100 times as large as the observed National Polyp Study cohort of 1,418 patients to minimize chance variation in the simulation results. The National Polyp Study surveillance schema and the observed compliance rates per arm and round are applied to the simulated trial population.…”

Section: Sensitivity Of Fictitious Screening Testmentioning

confidence: 99%

“…The assumed sensitivity of colonoscopy for cancer is 95% in the expert model, based on a retrospective study of colonoscopic sensitivity for cancer. 25 However, in the National Polyp Study, sigmoidoscopy or barium enema was performed as the reason for referral for colonoscopy in 25% and 44% of the patients, respectively, 34 and often additional colonoscopies were performed to resolve cases, which gives extra opportunities to detect cancer in these patients. Raising the sensitivity for preclinical cancer in the MISCAN-COLON model from 95% to 100% reduces the incidence from missed cancers.…”

Section: Table III -Cancer Incidence Rate and Proportion Of Surveillamentioning

confidence: 99%

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National Polyp Study data: Evidence for regression of adenomas

Loeve

Boer

Zauber

et al. 2004

Intl Journal of Cancer

134

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The data of the National Polyp Study, a large longitudinal study on surveillance of adenoma patients, is used for testing assumptions on the adenoma-carcinoma sequence. The observed adenoma and colorectal cancer incidence in the National Polyp Study were compared with the simulated outcomes of the MISCAN-COLON model of epidemiology and control of colorectal cancer for the U.S. population based on expert opinion. Variants of this model were explored in order to identify assumptions on the adenoma-carcinoma sequence that are consistent with the study observations. The high observed adenoma detection rates at surveillance and low observed colorectal cancer incidence in the National Polyp Study could only be explained by assuming a high incidence rate of adenomas accompanied by regression of adenomas. The National Polyp Study data suggest that adenoma prevalence results from a dynamic process of both formation as well as regression of adenomas. This lowers the expectations for the effects of colorectal cancer screening strategies that focus on adenoma detection.

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Section: Sensitivity Of Fictitious Screening Testmentioning

confidence: 99%

Section: Table III -Cancer Incidence Rate and Proportion Of Surveillamentioning

confidence: 99%

National Polyp Study data: Evidence for regression of adenomas

Loeve

Boer

Zauber

et al. 2004

Intl Journal of Cancer

134

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“…Technique of barium study and the interpretation of the findings on DCBE examination by radiologists also affect the accuracy of CRC detection. For instance, the sensitivity of DCBE for CRC was greater than that for single-contrast barium enema (85% vs 82%) (Rex et al, 1997). Double reporting of DCBE by different radiologists significantly reduced the miss rate and perceptive errors (Ott, 2000).…”

Section: 1273 Colorectal Cancer Screening By Double Contrast Barium mentioning

confidence: 96%

Colorectal Cancer Screening by Double Contrast Barium Enema in Thai People

Lohsiriwat

Prapasrivorakul²,

Suthikeeree³

2012

Asian Pacific Journal of Cancer Prevention

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“…Rex et al [10] initially suggested the possibility that endoscopist training was an important variable in colonoscopy quality and outcome when he reviewed colonoscopy and barium enema records from the previous 3 years in 2,193 consecutive patients with newly diagnosed CRC. They found that the sensitivity of colonoscopy in detecting CRC was significantly better for colonoscopies performed by gastroenterologists than those done by non-gastroenterologists (OR for missed CRC 5.36; 95% CI, 2.94-9.77).…”

mentioning

confidence: 99%

“…Nonetheless, there is now substantial data, including from the US that colonoscopy quality varies by specialty training in both a statistically and clinically meaningful manner with gastroenterologists typically having the lowest overall interval CRC rates. This issue has been discussed repeatedly [4,[6][7][8][9][10][11][12][13][14][15]; it is time for the medical community to act on this information.…”

mentioning

confidence: 99%

Isn’t It Time to Stop Talking About Colonoscopy Quality and Start Doing Something About It?

Patel

Ahnen

2011

Dig Dis Sci

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Colonoscopy is central to one of the great success stories of the war on cancer. Although colorectal cancer (CRC) is still the second leading cause of cancer death in the United States, both the incidence and mortality has been declining by 2-3% per year for the last 15 years. This decline has been largely attributed to increasing rates of CRC screening. Although guidelines list other screening options (stool tests/imaging/flexible sigmoidoscopy) colonoscopy has become the dominant CRC screening test in the US while fecal testing has declined slowly, and flexible sigmoidoscopy has declined markedly over the last decade [1].Colonoscopy is widely viewed in the US as the single best test for both detection and removal of pre-cancerous lesions. The efficacy of colonoscopic polypectomy was initially highlighted by the National Polyp Study (NPS), which estimated a 76-90% reduction in incidence of colorectal cancer after polyp removal [2]. Subsequent studies [3], which often have not shown as robust a CRC risk reduction as the NPS, have highlighted the importance of the quality of colonoscopy as a critical element in its efficacy.There is compelling evidence that colonoscopy quality is highly variable [4] and guidelines for a high-quality colonoscopy have been published [5], but in the end, quality needs to be assessed by whether a test accomplishes its primary goal. In the case of colonoscopy, directly measuring whether a colonoscopy has prevented a CRC is not feasible in the short term. Instead, more measurable surrogates of quality such as cecal intubation rates, withdrawal times, and particularly adenoma detection rates (ADR) have been used as quality measures. Kaminski et al. found that ADR appeared to be an acceptable surrogate for real colonoscopy quality as it was an independent predictor of the risk of interval colorectal cancer [6]. Numerous studies have demonstrated marked (twofold to sixfold) variability in ADRs among endoscopists working in the same endoscopy unit [4]. Although some of this variability might be due to patient factors such as age, gender, or adequacy of bowel preparation, individual endoscopists appear to be the single most predictive factor in adenoma detection [7], implying that the efficacy of colonoscopy is highly dependent on the individual skill of the endoscopist. To compound matters, Brenner [8] and Lakoff [9] presented data from Germany and Canada that showed that while colonoscopy does decrease the rate of distal CRCs by approximately 67-79%, it was not at all protective for proximal colon cancers, suggesting that there is a substantial need for improvement in colonoscopy quality by all endoscopists.The variability in colonoscopy quality among providers and the dubious utility of colonoscopy in preventing rightsided colon cancers have called into question the overall efficacy of colonoscopy as it is used today and would seem to be a clear mandate for endoscopists and professional organizations to critically examine colonoscopist performance and address areas in need of improvement...

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Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice

Cited by 530 publications

References 5 publications

National Polyp Study data: Evidence for regression of adenomas

National Polyp Study data: Evidence for regression of adenomas

Colorectal Cancer Screening by Double Contrast Barium Enema in Thai People

Isn’t It Time to Stop Talking About Colonoscopy Quality and Start Doing Something About It?

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