Adenoma detection rate and risk of colorectal cancer and death.
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.).
From the Division of Research, Kaiser Permanente, Oakland (D.A.C., C.D.J., A.R.M., W.K.Z., J.K.L., J.B., B.H.F., T.R.L., C.P.Q.), and Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.E.S., V.P.Q., N.R.G.) - both in California; the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (C.A.D.); and the Department of Public Health, Memorial Sloan-Kettering Cancer Center, New York (A.G.Z.).
Douglas A
DA
Corley
Christopher D
CD
Jensen
Amy R
AR
Marks
Wei K
WK
Zhao
Jeffrey K
JK
Lee
Chyke A
CA
Doubeni
Ann G
AG
Zauber
Jolanda
J
de Boer
Bruce H
BH
Fireman
Joanne E
JE
Schottinger
Virginia P
VP
Quinn
Nirupa R
NR
Ghai
Theodore R
TR
Levin
Charles P
CP
Quesenberry
D000236:Adenoma / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D012306:Risk; D014481:United States / Q000453:epidemiology