BACKGROUND: The proportion of screening colonoscopic examinations performed by a physician that detect one or more adenomas (the adenoma detection rate) is a recommended quality measure. However, little is known about the association between this rate and patients' risks of a subsequent colorectal cancer (interval cancer) and death. METHODS: Using data from an integrated health care delivery organization, we evaluated the associations between the adenoma detection rate and the risks of colorectal cancer diagnosed 6 months to 10 years after colonoscopy and of cancer-related death. With the use of Cox regression, our estimates of attributable risk were adjusted for the demographic characteristics of the patients, indications for colonoscopy, and coexisting conditions. RESULTS: We evaluated 314,872 colonoscopies performed by 136 gastroenterologists; the adenoma detection rates ranged from 7.4 to 52.5%. During the follow-up period, we identified 712 interval colorectal adenocarcinomas, including 255 advanced-stage cancers, and 147 deaths from interval colorectal cancer. The unadjusted risks of interval cancer according to quintiles of adenoma detection rates, from lowest to highest, were 9.8, 8.6, 8.0, 7.0, and 4.8 cases per 10,000 person-years of follow-up, respectively. Among patients of physicians with adenoma detection rates in the highest quintile, as compared with patients of physicians with detection rates in the lowest quintile, the adjusted hazard ratio for any interval cancer was 0.52 (95% confidence interval [CI], 0.39 to 0.69), for advanced-stage interval cancer, 0.43 (95% CI, 0.29 to 0.64), and for fatal interval cancer, 0.38 (95% CI, 0.22 to 0.65). Each 1.0% increase in the adenoma detection rate was associated with a 3.0% decrease in the risk of cancer (hazard ratio, 0.97; 95% CI, 0.96 to 0.98). CONCLUSIONS: The adenoma detection rate was inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer. (Funded by the Kaiser Permanente Community Benefit program and the National Cancer Institute.).
BACKGROUND: The proportion of screening colonoscopic examinations performed by a physician that detect one or more adenomas (the adenoma detection rate) is a recommended quality measure. However, little is known about the association between this rate and patients' risks of a subsequent colorectal cancer (interval cancer) and death. METHODS: Using data from an integrated health care delivery organization, we evaluated the associations between the adenoma detection rate and the risks of colorectal cancer diagnosed 6 months to 10 years after colonoscopy and of cancer-related death. With the use of Cox regression, our estimates of attributable risk were adjusted for the demographic characteristics of the patients, indications for colonoscopy, and coexisting conditions. RESULTS: We evaluated 314,872 colonoscopies performed by 136 gastroenterologists; the adenoma detection rates ranged from 7.4 to 52.5%. During the follow-up period, we identified 712 interval colorectal adenocarcinomas, including 255 advanced-stage cancers, and 147 deaths from interval colorectal cancer. The unadjusted risks of interval cancer according to quintiles of adenoma detection rates, from lowest to highest, were 9.8, 8.6, 8.0, 7.0, and 4.8 cases per 10,000 person-years of follow-up, respectively. Among patients of physicians with adenoma detection rates in the highest quintile, as compared with patients of physicians with detection rates in the lowest quintile, the adjusted hazard ratio for any interval cancer was 0.52 (95% confidence interval [CI], 0.39 to 0.69), for advanced-stage interval cancer, 0.43 (95% CI, 0.29 to 0.64), and for fatal interval cancer, 0.38 (95% CI, 0.22 to 0.65). Each 1.0% increase in the adenoma detection rate was associated with a 3.0% decrease in the risk of cancer (hazard ratio, 0.97; 95% CI, 0.96 to 0.98). CONCLUSIONS: The adenoma detection rate was inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer. (Funded by the Kaiser Permanente Community Benefit program and the National Cancer Institute.).
Authors: Robert E Schoen; Paul F Pinsky; Joel L Weissfeld; Robert S Bresalier; Timothy Church; Philip Prorok; John K Gohagan Journal: JAMA Date: 2003-07-02 Impact factor: 56.272
Authors: Perry J Pickhardt; Pamela A Nugent; Pauline A Mysliwiec; J Richard Choi; William R Schindler Journal: Ann Intern Med Date: 2004-09-07 Impact factor: 25.391
Authors: M Bretthauer; E Skovlund; T Grotmol; E Thiis-Evensen; G Gondal; G Huppertz-Hauss; P Efskind; B Hofstad; S Thorp Holmsen; T J Eide; G Hoff Journal: Scand J Gastroenterol Date: 2003-12 Impact factor: 2.423
Authors: Brian Bressler; Lawrence F Paszat; Christopher Vinden; Cindy Li; Jingsong He; Linda Rabeneck Journal: Gastroenterology Date: 2004-08 Impact factor: 22.682
Authors: Ateev Mehrotra; Michele Morris; Rebecca A Gourevitch; David S Carrell; Daniel A Leffler; Sherri Rose; Julia B Greer; Seth D Crockett; Andrew Baer; Robert E Schoen Journal: Gastrointest Endosc Date: 2017-09-01 Impact factor: 9.427
Authors: Felippe O Marcondes; Katie M Dean; Robert E Schoen; Daniel A Leffler; Sherri Rose; Michele Morris; Ateev Mehrotra Journal: Gastrointest Endosc Date: 2015-10 Impact factor: 9.427
Authors: Cassandra D L Fritz; Zachary L Smith; Jeffrey Elsner; Thomas Hollander; Dayna Early; Vladimir Kushnir Journal: Dig Dis Sci Date: 2018-05-03 Impact factor: 3.199
Authors: Gottumukkala S Raju; Phillip J Lum; Rebecca S Slack; Selvi Thirumurthi; Patrick M Lynch; Ethan Miller; Brian R Weston; Marta L Davila; Manoop S Bhutani; Mehnaz A Shafi; Robert S Bresalier; Alexander A Dekovich; Jeffrey H Lee; Sushovan Guha; Mala Pande; Boris Blechacz; Asif Rashid; Mark Routbort; Gladis Shuttlesworth; Lopa Mishra; John R Stroehlein; William A Ross Journal: Gastrointest Endosc Date: 2015-04-22 Impact factor: 9.427