Increased Rate of Adenoma Detection Associates With Reduced Risk of Colorectal Cancer and Death.

BACKGROUND & AIMS The quality of endoscopists' colonoscopy performance is measured by adenoma detection rate (ADR). Although ADR is associated inversely with interval colorectal cancer and colorectal cancer death, the effects of an increasing ADR have not been shown. We investigated whether increasing ADRs from individual endoscopists is associated with reduced risks of interval colorectal cancer and subsequent death. METHODS We performed 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. We collected data from 146,860 colonoscopies performed by 294 endoscopists, with each endoscopist having participated at least twice in annual editions of primary colonoscopy screening. We used annual feedback and quality benchmark indicators to improve colonoscopy performance. We used ADR quintiles in the whole data set to categorize the annual ADRs for each endoscopist. An increased ADR was defined as an increase by at least 1 quintile category, or the maintenance of the highest category in subsequent screening years. Multivariate frailty models were used to evaluate the effects of increased ADR on the risk of interval colorectal cancer and death. RESULTS 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, we identified 168 interval colorectal cancers and 44 interval cancer deaths. An increased ADR was associated with an adjusted hazard ratio for interval colorectal cancer of 0.63 (95% confidence interval [CI], 0.45-0.88; P = .006), and for cancer death of 0.50 (95% CI, 0.27-0.95; P = .035). 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 to 0.27 (95% CI, 0.12-0.63; P = .003), and 0.18 (95% CI, 0.06-0.56; P = .003), respectively. CONCLUSIONS In a prospective study of individuals who underwent screening colonoscopy within a National Colorectal Cancer Screening Program, we associated increased ADR with a reduced risk of interval colorectal cancer and death.

[1]  Siwan Thomas-Gibson,et al.  Leadership training to improve adenoma detection rate in screening colonoscopy: a randomised trial , 2015, Gut.

[2]  W. Schmiegel,et al.  Current status of screening colonoscopy in Europe and in the United States. , 2007, Endoscopy.

[3]  Marcin Polkowski,et al.  Quality indicators for colonoscopy and the risk of interval cancer. , 2010, The New England journal of medicine.

[4]  G. Meijer,et al.  Definition and taxonomy of interval colorectal cancers: a proposal for standardising nomenclature , 2014, Gut.

[5]  J. Johanson,et al.  Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. , 2006, The New England journal of medicine.

[6]  T. Church,et al.  Longer Withdrawal Time Is Associated With a Reduced Incidence of Interval Cancer After Screening Colonoscopy. , 2015, Gastroenterology.

[7]  Douglas K. Rex,et al.  Quality Indicators for Colonoscopy , 2006, Gastrointestinal endoscopy.

[8]  P. Hougaard,et al.  Frailty models for survival data , 1995, Lifetime data analysis.

[9]  Michael B Wallace,et al.  An Endoscopic Quality Improvement Program Improves Detection of Colorectal Adenomas , 2013, The American Journal of Gastroenterology.

[10]  C Senore,et al.  European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition – Quality assurance in endoscopy in colorectal cancer screening and diagnosis , 2012, Endoscopy.

[11]  J. Didkowska,et al.  Nowotwory w Polsce w 2012 roku , 2013 .

[12]  Paul Collins,et al.  Colonoscopic withdrawal times and adenoma detection during screening colonoscopy , 2007 .

[13]  Robert H Fletcher,et al.  Guidelines for Colonoscopy Surveillance after Polypectomy: A Consensus Update by the US Multi‐Society Task Force on Colorectal Cancer and the American Cancer Society * , † , 2006, Gastroenterology.

[14]  P. Bossuyt,et al.  Polyp Miss Rate Determined by Tandem Colonoscopy: A Systematic Review , 2006, The American Journal of Gastroenterology.

[15]  M. Kaminski,et al.  Adenoma Detection Race at Colonoscopy: The Good and the Bad. , 2015, Gastroenterology.

[16]  H. Brenner,et al.  Trends in Adenoma Detection Rates During the First 10 Years of the German Screening Colonoscopy Program. , 2015, Gastroenterology.

[17]  J. Reguła,et al.  Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. , 2006, The New England journal of medicine.

[18]  C. Hassan,et al.  Efficacy and cost-effectiveness of screening colonoscopy according to the adenoma detection rate , 2015, United European gastroenterology journal.

[19]  Christopher D. Jensen,et al.  Variation in Adenoma Detection Rate and the Lifetime Benefits and Cost of Colorectal Cancer Screening: A Microsimulation Model. , 2015, JAMA.

[20]  Christopher D. Jensen,et al.  Can we improve adenoma detection rates? A systematic review of intervention studies. , 2011, Gastrointestinal endoscopy.

[21]  G. Elta,et al.  Quality assurance of training. , 2011, Best practice & research. Clinical gastroenterology.

[22]  Christopher D. Jensen,et al.  Adenoma detection rate and risk of colorectal cancer and death. , 2014, The New England journal of medicine.

[23]  M. Kaminski,et al.  Design of the Polish Colonoscopy Screening Program: a randomized health services study , 2015, Endoscopy.

[24]  M. Kaminski,et al.  Continuous Quality Improvement of Screening Colonoscopy: Data from a Large Colorectal Cancer Screening Program , 2009 .