Adenoma Detection Rate and Risk of Colorectal Cancer and Death
By D. Corley, Christopher D. Jensen, A. Marks, Wei K. Zhao, Jeffrey-K Lee, Chyke A Doubeni, A. Zauber, Jolanda de Boer, B. Fireman, J. Schottinger and 4 more. New England Journal of Medicine, 2014
1,048 citations recorded by the source corpus.
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.)
Subfields: Oncology, Pulmonary and Respiratory Medicine
View Paper: https://www.semanticscholar.org/paper/e0cb208735832bc600fef49a5303a037928bd5e6
How researchers see this paper
The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.
In Oncology
In Pulmonary and Respiratory Medicine
Citations in the corpus
- Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model (2017, background): “30 This operator dependence leads to substantial variation between endoscopists in their effectiveness in preventing CRC with colonoscopy, 31 32 which is the fundamental goal of most colonoscopies.”
- Performance of artificial intelligence for colonoscopy regarding adenoma and polyp detection: a meta-analysis. (2020, background): “Interval colorectal cancer (CRC) represents one of the most dismal consequences of screening colonoscopy with an incidence of 0.5 to 1 per 1000 patient-years 1,2 .”
- Deep Learning Localizes and Identifies Polyps in Real Time with 96% Accuracy in Screening Colonoscopy (2018, background): “A large Kaiser Permanente study showed that for each 1% increase in ADR, interval cancer rate was reduced by 3% 8 .”