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

Umar, Sarah B.; Ramirez, Francisco C.

doi:10.21037/tgh.2017.11.10

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…Some factors that may improve ADR include split-dose preparation, and provider education on flat and depressed lesions and on withdrawal technique and public reporting of ADR (5,28). Several studies have demonstrated improvement in ADR through regular feedback and monitoring (29).…”

Section: Discussionmentioning

confidence: 99%

Variations in Screening Quality in a Federal Colorectal Cancer Screening Program for the Uninsured

et al. 2019

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Introduction Screening can decrease colorectal cancer incidence and mortality and is recommended in clinical practice guidelines. Poor quality of colorectal cancer screening can negate the benefit of screening. The objective of this study was to assess the quality of screening services provided by the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program from July 2009 through June 2015. Methods We collected data from the program’s 29 grantees, funded to provide colorectal cancer screening and diagnostic services to asymptomatic, low-income, and underinsured or uninsured adults aged 50 to 64. We collected data on the dates and results of all screening and diagnostic tests and, for colonoscopies, on whether the cecum was reached, whether bowel preparation was adequate, and endoscopists’ recommendations for the next test. Results Overall, 82.9% (range among grantees, 50.0%–97.2%) of positive FOBTs/FITs were followed up by colonoscopy; 95.2% of colonoscopies occurred within 180 days of the positive stool test. Cecal intubation rates ranged among grantees from 94.2% to 100%. Adenoma detection rates met recommended threshold levels for almost all grantees. Recommendations for rescreening and surveillance intervals deviated from guidelines in both directions. Of clients with normal colonoscopies, 85.3% (range, 37.7%–99.7%) were told to return in 10 years, as recommended in national guidelines. Of clients with advanced adenomas, 55.2% (range, 20.0%–84.6%) were told to return in 3 years as recommended, 25.4% (range, 3.8%–56.6%) in 5 or more years, and 18.6% (range, 0%–47.2%) in less than 3 years. Conclusion Although overall screening quality was good, it varied considerably. Ongoing monitoring to identify performance problems is essential for all colorectal cancer screening activities, so that efforts designed to improve performance can be targeted to individual clinicians.

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Section: Discussionmentioning

confidence: 99%

Variations in Screening Quality in a Federal Colorectal Cancer Screening Program for the Uninsured

et al. 2019

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“…In addition, more than 90% of colon cancers are adenocarcinomas, with HGD being the main precursors ( 13 – 17 ). Thus, it is critically important to identify patients who are more prone to CRC among the endoscopic screening cohort ( 10 , 18 ). It has been well-acknowledged that there is a strong correlation between the diameter of colorectal polyps and the development of CRC ( 19 – 23 ).…”

Section: Introductionmentioning

confidence: 99%

The absolute number of small and diminutive adenomas with high-grade dysplasia is substantially higher compared with large adenomas: a retrospective pooled study

Zhang,

Sun,

Xiong

et al. 2024

Front. Oncol.

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IntroductionThe risk that a large polyp (≥10 mm) evolves into high-grade dysplasia (HGD) is relatively high compared with that of a small/diminutive polyp (<10 mm). Recently, the detection of small and diminutive polyps has been substantially improved with the advancement of endoscopy. However, further research is needed on the role of the incidence of HGD caused by the co-occurrence of small and diminutive polyps in the progression of HGD. In this study, we aim to investigate whether and how the small and diminutive polyps correlate with the incidence of HGD in the population.MethodsThe pooled data were deeply analyzed from four published randomized controlled trials (RCTs) regarding colon polyp detection. All polyps detected were examined and confirmed by pathologists. The primary outcome was the composition ratio of the HGD polyps in each polyp size category.ResultsAmong a total of 3,179 patients with 2,730 polyps identified, there were 83 HGD polyps confirmed, and 68 patients had at least one polyp with HGD. The risk of development of HGD was lower for a single small and diminutive polyp than for one large polyp (2.18% vs. 22.22%, P < 0.0001). On the contrary, the composition ratio for HGD from small and diminutive polyps was significantly higher than that from the large ones (68.67% vs. 31.33%, P < 0.0001). The combined number of HGD presented a trend negatively correlated to size.ConclusionsOur data demonstrated that the absolute number of HGD significantly derives more from small and diminutive polyps than from the large ones, and the collective number of small and diminutive polyps per patient is indicative of his/her HGD exposure. These findings positively provide novel perspectives on the management of polyps and may further optimize the prevention of colorectal cancer.Systematic Review Registrationhttp://www.chictr.org.cn, identifier ChiCTR1900025235, ChiCTR1800017675, ChiCTR1800018058, and ChiCTR1900023086.

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“…Considerable evidence demonstrates that there is a close correlation between polyps and colorectal cancer (CRC) [1,2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12].In addition, the prevalence and distribution of HGD (The gateway of adenocarcinoma) [13] [14], account for more than 90% of CRC incidents [15] [16]. Thus, it is critically important to identify patients who are more prone to CRC among the endoscopic screening cohort [10,17].…”

Section: Introductionmentioning

confidence: 99%

The absolute number of high-grade dysplasia (HGD) is substantially higher from micro-polyps compared to that from larger size polyps, a retrospective pooled study

Zhang,

Sun,

Xiong

et al. 2023

Preprint

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Importance: The risk that a large polyp (≥10mm) develops into high-grade dysplasia (HGD) is relatively high compared to that of a micro polyp (<10mm). Recently, the detection of micro polyps has been substantially improved with the advancement of endoscopy. However, the incidence of HGD caused by the combined number of micro polyps in the progression of HGD remains to be clarified. Objective: In this study, we aim to investigate whether and how the micro and diminutive polyps correlate with the incidents of HGD in population. Evidence Review: The pooled data were deeply analyzed from four published randomized controlled trials (RCTs) regarding colon polyp detection. HGD was confirmed through histopathology. The primary outcome was the correlation between the size of detected polyps with the confirmed HGD incident rate. Findings: Among a total of 3,179 patients with 2,730 polyps identified, there were 83 HGD polyps confirmed, and 68 patients had at least one polyp with HGD. The risk of development of HGD was lower for a single micro-polyp compared to that for one large polyp (2.18% vs 22.22%, p<0.0001). On the contrary, the constitutional ratio for HGD from micro polyps was significantly higher than that from the large ones (68.67% vs 31.33%, p<0.0001). Furthermore, the total number of micro polyps per patient was positively correlated to the total number of HGD (p<0.0001). The combined number of HGD presented a trend to be negatively correlated to its size. Conclusions: Our data demonstrated that the absolute number of HGD significantly derives more from micro polyps than that from the large ones, and the collective number of micro polyps per patient is indicative of his/her HGD exposure. These findings positively provide novel perspectives on the management of polyps, and further may optimize the prevention of colorectal cancer.

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

Cited by 3 publications

References 16 publications

Variations in Screening Quality in a Federal Colorectal Cancer Screening Program for the Uninsured

Variations in Screening Quality in a Federal Colorectal Cancer Screening Program for the Uninsured

The absolute number of small and diminutive adenomas with high-grade dysplasia is substantially higher compared with large adenomas: a retrospective pooled study

The absolute number of high-grade dysplasia (HGD) is substantially higher from micro-polyps compared to that from larger size polyps, a retrospective pooled study

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