July 19, 2017
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Increased adenoma detection rate linked to lower CRC, death risk

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Investigators found that improvement in an individual endoscopist’s adenoma detection rate was associated with reduced risks for colorectal cancer and subsequent death in a prospective cohort study.

“Adenoma detection rate is a well-recognized colonoscopy quality measure, [and though the] associations between adenoma detection rate and interval colorectal cancer risk and colorectal cancer death have been shown before, the impact of adenoma detection rate improvement on these outcomes has not been yet proven,” Paulina Wieszczy, MSc, a biostatistician in the department of gastroenterology, hepatology and oncology at the Medical Center for Postgraduate Education, and the department of cancer prevention at the Maria-Sklodowska-Curie Memorial Cancer Center and Institute of Oncology in Warsaw, Poland, said in an AGA video abstract.

Wieszczy and colleagues evaluated data on 146,860 screening colonoscopies performed by 294 endoscopists from 2004 through 2008. All the endoscopists received annual feedback and quality benchmarking to improve their performance, and their ADRs were assessed by quintiles, the highest of which exceeded an ADR of 24.56%.

During the study period, 74.5% of the endoscopists increased their annual ADR category from baseline.

After a median follow-up of 5.8 years (895,916 person-years), 168 interval colorectal cancers and 44 interval cancer deaths occurred.

“We showed that when compared to no increase, an increase by at least one adenoma detection rate category was associated with 37% decrease in interval colorectal cancer risk and 50% decrease in colorectal cancer death,” Wieszczy said. “Moreover, reaching or maintaining the highest adenoma detection rate category lowered the risk of interval cancer by 73% and 92%, respectively.”

The adjusted hazard ratios were:

  • 0.63; 95% CI, 0.45-0.88 for increased ADR and interval CRC risk;
  • 0.5; 95% CI, 0.27-0.95 for increased ADR and CRC death risk;
  • 0.27; 95% CI, 0.12-0.63 for reaching the highest quintile ADR category and interval CRC risk vs. no increase; and
  • 0.18; 95% CI, 0.06-0.56 for maintaining the highest quintile ADR category and interval CRC risk vs. no increase.

“In conclusion, increase of adenoma detection rate leads to a decrease of interval colorectal cancer risk and death,” Wieszczy said in the video abstract.

The investigators acknowledged that the observational design and relatively small number of annual colonoscopies performed limit the study findings.

In a related editorial, Cesare Hassan, MD, of the endoscopy unit at Nuovo Regina Margherita Hospital, Italy, and Alessandro Repici, MD, of the endoscopy unit at Humanitas University, Italy, described this finding as a “circular association between ADR improvement and interval cancer [that] offers a completely new perspective,” and they argued that these data support “the adoption of circular policies aimed to audit and improve ADR to achieve the desired CRC prevention target.

“Where there was a monotonic line relating baseline ADR with the risk of interval cancer, there is now a revitalizing circle offering a new and better life to endoscopists and patients altogether,” they concluded. – by Adam Leitenberger

Reference: Wieszczy P. AGA video abstract: Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death. June 20, 2017. https://www.youtube.com/watch?v=b55mG6D2I0M&t=2s. Accessed July 19, 2017.

Disclosures: The researchers report no relevant financial disclosures.