Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840 149 screening colonoscopies

Abstract

Objectives: To derive age and sex specific estimates of transition rates from advanced adenomas to colorectal cancer by combining data of a nationwide screening colonoscopy registry and national data on colorectal cancer (CRC) incidence. Design: Registry based study. Setting: National screening colonoscopy programme in Germany. Patients: Participants of screening colonoscopy in 2003 and 2004 (n = 840 149). Main outcome measures: Advanced adenoma prevalence, colorectal cancer incidence, annual and 10 year cumulative risk of developing CRC among carriers of advanced adenomas according to sex and age (range 55-80+ years) Results: The age gradient is much stronger for CRC incidence than for advanced adenoma prevalence. As a result, projected annual transition rates from advanced adenomas to CRC strongly increase with age (from 2.6% in age group 55-59 years to 5.6% in age group >80 years among women, and from 2.6% in age group 55-59 years to 5.1% in age group >80 years among men). Projections of 10 year cumulative risk increase from 25.4% at age 55 years to 42.9% at age 80 years in women, and from 25.2% at age 55 years to 39.7% at age 80 years in men. Conclusions: Advanced adenoma transition rates are similar in both sexes, but there is a strong age gradient for both sexes. Our estimates of transition rates in older age groups are in line with previous estimates derived from small case series in the pre-colonoscopy era independent of age. However, our projections for younger age groups are considerably lower. These findings may have important implications for the design of CRC screening programmes.

Using the Cancer Risk Management Model to Evaluate Colorectal Cancer Screening Options for Canada

“…Data on stage distribution and stage-specific crc survival were obtained from Canadian sources 12 . Another review of the literature identified information about adenomatous polyp prevalence, incidence, growth rates, variation by sex, size, site distribution, and histology [13][14][15][16][17][18][19][20][21][22][23][24] . Where possible, the literature was used to directly estimate parameters for the model; otherwise, it was used to inform parameter values for the model through calibration and provision of targets.…”

The Impact of Colonoscopy on Colorectal Cancer Incidence and Mortality

“…The development of advanced adenomas may take less time that that of CRC. In addition, the 10-year cumulative risk of progressing from advanced adenoma to CRC is estimated to be less than 50% in individuals 55 years or older (Brenner et al, 2007). Second, the frequency of patients with right-sided CRC in the second study was much higher compared to the number of patients with right-sided advanced neoplasms in the first study, resulting in better statistics.…”

False-positive results in colorectal cancer screening: what do we know?

“…Advanced adenomas have been considered to be the clinical precursors of CRC; however, we have to take into account that available estimates for the progression of adenomas were mostly derived from radiological surveillance data or from autopsy series collected prior to the colonoscopy era. Since advanced adenomas need to be removed once they are detected, any direct observation of their natural history would be unethical [18].…”