Increased adenoma detection rate associated with lower risk of colorectal cancer and death

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An increased ADR is associated with an adjusted hazard ratio of 0.63 for interval colorectal cancer and 0.50 for cancer death.
An increased ADR is associated with an adjusted hazard ratio of 0.63 for interval colorectal cancer and 0.50 for cancer death.

An increased adenoma detection rate (ADR) is associated with a reduced risk of interval colorectal cancer and death, according to a study published in Gastroenterology.

Michal F. Kaminski, from the Center of Oncology Institute and Medical Center for Postgraduate Education in Warsaw, Poland, and colleagues conducted a prospective cohort study of individuals who underwent a screening colonoscopy within the National Colorectal Cancer Screening Program in Poland from January 1, 2004, through December 31, 2008. Subjects were included if their endoscopist participated in at least 30 screening colonoscopies and in at least 2 annually held screening programs.

The authors collected data from 146,860 colonoscopies performed by 294 endoscopists. Participants were followed up from the date of colonoscopy to a diagnosis of interval colorectal cancer, date of scheduled surveillance, death, or end of the follow-up period (December 31, 2013).

Of the 158,950 individuals who underwent colonoscopy, 12,090 (7.6%) were excluded, leaving a total of 146,860 participants. Throughout the enrollment period, 219 endoscopists (74.5%) increased their annual ADR category. During 895,916 person-years of follow-up evaluation through the National Cancer Registry, the authors identified 168 interval colorectal cancers and 44 interval cancer deaths.

An increased ADR was associated with an adjusted hazard ratio of 0.63 for interval colorectal cancer and 0.50 for cancer death. Compared with no increase in ADR, reaching or maintaining the highest quintile ADR category (such as an ADR > 24.56%) decreased the adjusted hazard ratios for interval colorectal cancer and death to 0.27 and 0.18, respectively.

“We now show that an improvement in adenoma detection rate at screening colonoscopy, achieved by a comprehensive quality-assurance program, translates into reduced risks of interval colorectal cancer and colorectal cancer death,” reported the authors.

Reference

  1. Kaminski MF, Wieszczy P, Rupinski M, et al. Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death. Gastroenterology. July 2017. doi: 10.1053/j.gastro.2017.04.006
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