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.
Using data from an integrated health care delivery organization, Dr Douglas Corley and colleagues 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, the team's estimates of attributable risk were adjusted for the demographic characteristics of the patients, indications for colonoscopy, and coexisting conditions.
The researchers evaluated 314,872 colonoscopies performed by 136 gastroenterologists.
|The adenoma detection rates ranged from 7% to 53%|
|New England Journal of Medicine|
The research team noted the adenoma detection rates ranged from 7% to 53%.
During the follow-up period, the researchers 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, for advanced-stage interval cancer, 0.43, and for fatal interval cancer, 0.38.
The team observed that each 1% increase in the adenoma detection rate was associated with a 3% decrease in the risk of cancer.
Dr Corley's team concludes, "The adenoma detection rate was inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer."