Trends in Adenoma Detection Rates During the First 10 Years of the German Screening Colonoscopy Program.
OBJECTIVE
The adenoma detection rate (ADR) is an important quality indicator of screening colonoscopy; it is inversely associated with risk of interval cancers and colorectal cancer mortality. We assessed trends in the ADR in the first 10 years of the German screening colonoscopy program.


METHODS
We calculated age-adjusted and age-specific detection rates of nonadvanced adenomas and advanced adenomas for each calendar year based on 4.4 million screening colonoscopies conducted from 2003 through 2012 and reported to the German screening colonoscopy registry.


RESULTS
We observed a steady and strong increase in rate of detection of nonadvanced adenomas in both sexes and all age groups. Age-adjusted rates of detection of nonadvanced adenomas increased from 13.3% to 22.3% among men and from 8.4% to 14.9% among women. This increase was mostly due to an increase in detection rates of adenomas <0.5 cm, and it is partly explained by an innovation effect (higher ADRs among incoming colonoscopists than among leaving colonoscopists, and relatively stable ADRs among continuing colonoscopists). Only modest increases were observed in detection rates of advanced adenomas (from 7.4% to 9.0% among men, and from 4.4% to 5.2% among women) and colorectal cancer. In 2012, overall ADR reached 31.3% and 20.1% in men and women, respectively.


CONCLUSIONS
We observed a strong increase in ADRs from 2003 through 2012 in Germany. Although we cannot exclude the effects of secular trends in colorectal neoplasm prevalence, the observed increase was mainly the result of a steady increase in detection of nonadvanced adenomas (especially adenomas <0.5 cm). Further research should address potential implications for defining screening and surveillance intervals.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: h.brenner@dkfz.de.
Hermann
H
Brenner
Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany.
Lutz
L
Altenhofen
Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany.
Jens
J
Kretschmann
Interdisciplinary Endoscopy Department and Clinic, University Clinic Hamburg, Hamburg, Germany.
Thomas
T
Rösch
Department of Medicine, Ruhr University Bochum, Knappschaftskrankenhaus, Germany.
Christian
C
Pox
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Christian
C
Stock
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Michael
M
Hoffmeister
D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D029681:Arabidopsis Proteins; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D008875:Middle Aged; D009687:Nuclear Proteins; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
D029681:Arabidopsis Proteins; D009687:Nuclear Proteins; C523534:TIC protein, Arabidopsis
Colon Cancer; Colorectal Neoplasms; Endoscopy; Prevention