The value of age and medical history for predicting colorectal cancer and adenomas in people referred for colonoscopy

Abstract

BackgroundColonoscopy is an invasive and costly procedure with a risk of serious complications. It would therefore be useful to prioritise colonoscopies by identifying people at higher risk of either cancer or premalignant adenomas. The aim of this study is to assess a model that identifies people with colorectal cancer, advanced, large and small adenomas.MethodsPatients seen by gastroenterologists and colorectal surgeons between April 2004 and December 2006 completed a validated, structured self-administered questionnaire prior to colonoscopy. Information was collected on symptoms, demographics and medical history. Multinomial logistic regression was used to simultaneously assess factors associated with findings on colonoscopy of cancer, advanced adenomas and adenomas sized 6 -9 mm, and ≤ 5 mm. The area under the curve of ROC curve was used to assess the incremental gain of adding demographic variables, medical history and symptoms (in that order) to a base model that included only age.ResultsSociodemographic variables, medical history and symptoms (from 8,204 patients) jointly provide good discrimination between colorectal cancer and no abnormality (AUC 0.83), but discriminate less well between adenomas and no abnormality (AUC advanced adenoma 0.70; other adenomas 0.67). Age is the dominant risk factor for cancer and adenomas of all sizes. Having a colonoscopy within the last 10 years confers protection for cancers and advanced adenomas.ConclusionsOur models provide guidance about which factors can assist in identifying people at higher risk of disease using easily elicited information. This would allow colonoscopy to be prioritised for those for whom it would be of most benefit.

Findings in young adults at colonoscopy from a hospital service database audit

“…Family history was self-reported and not systematically verified, and indications for colonoscopy were extracted from admission notes. Allowing for these limitations, results showed that adenoma prevalence rises with age, and this is in keeping with what would be expected in the general population [53]. This report also confirms a recent publication demonstrating that advanced polyps in patients under 45 are more likely to be sporadic than associated with family history, as family history of CRC was reported in 7.1% of those with any advanced neoplasia [54].…”

Validation of the Asia Pacific Colorectal Screening (APCS) score in a Western population: An alternative screening tool

“…12 The correlation between colonic neoplasia with lower gastrointestinal (GI) symptoms is poor, and population investigation based on symptoms alone is not recommended. [15][16][17] Current CRC screening programs do not all stratify for established CRC risk factors beyond age, such as family history, sex, smoking status, and body mass index (BMI). [7][8][9][10][11] Incorporating simple demographic factors to screen appropriately at-risk populations or triaging those with risk factors may improve health care utilization by reducing futile colonoscopies.…”

Improving the utility of colonoscopy: Recent advances in practice

“…The cost of unnecessary normal colonoscopy is substantial, and the potential cost saving of more efficient triage of colonoscopy is large. There is poor correlation between colonic polyps and lower gastrointestinal (GI) symptoms, and symptom‐based screening is not recommended . Current screening programs do not stratify for established risk factors other than age; such as family history, sex, smoking status, and body mass index (BMI).…”

“…There is poor correlation between colonic polyps and lower gastrointestinal (GI) symptoms, and symptom-based screening is not recommended. [33][34][35] Current screening programs do not stratify for established risk factors other than age; such as family history, sex, smoking status, and body mass index (BMI). Some countries have adopted fecal occult blood test (FOBT) screening to decrease the burden of colonoscopy.…”