title: Long-term risk of colorectal cancer by gender after positive colonoscopy: population-based cohort study.
abstract: Evidence for surveillance intervals of colonoscopy are primarily based on adenoma recurrence rate rather than on colorectal cancer (C.R.C.) incidence. Little is known about long-term risk of C.R.C. after positive colonoscopy. In view of men have significantly higher C.R.C. risk than women, we aimed to estimate the gender-specific C.R.C. incidence after positive colonoscopy (adenoma or malignant lesion) at follow-up colonoscopy.
  
  
  
  A retrospective cohort study was conducted using data from a database of colonoscopy screening and surveillance. Patients having had a colonoscopy (January 2010-March 2014) were selected as study subjects and the history of prior colonoscopies was reviewed. Multivariable Weibull regression models were used to estimate the incidence of C.R.C. at follow-up colonoscopy for subjects who were assigned a stratified risk level. The benchmark risk was defined according to a national survey.
  
  
  
  The interval incidence of C.R.C. at a 10 year follow-up was 164 (95% C.I. 63-343) and 79 (95% C.I. 26-188) per 100,000 person-years for low-risk men and women respectively, which tallied with our benchmark risk. Men exceeded the benchmark risk in 3-5 years if they had an incomplete polyp removal, ≥3 adenomas during their last colonoscopy or a personal C.R.C. history, and in 7-8 years if they only had familial C.R.C.
  
  
  
  Women had a lower risk of C.R.C., and reached a same risk level 3-5 years later than men. Coexisting above risk factors resulted in a sharp increase in the incidence of C.R.C. at follow-up exceeding the benchmark much earlier.
  
  
  
  Surveillance intervals for men based on incidence of C.R.C. are in line with that recommended by the current guidelines for colonoscopy. However, an extension of 3-5 years may be appropriate for women. To target personalized medicine, a risk predictive model could be used to identify an appropriate surveillance interval for each individual in the future.
authors.affiliation: a Center for Outcomes Research, University of Illinois College of Medicine at Peoria , IL , USA ;
authors.forename: Jinma
authors.initials: J
authors.lastname: Ren
authors.affiliation: a Center for Outcomes Research, University of Illinois College of Medicine at Peoria , IL , USA ;|b University of Illinois College of Nursing at Chicago , IL , USA ;
authors.forename: Carmen S
authors.initials: CS
authors.lastname: Kirkness
authors.affiliation: a Center for Outcomes Research, University of Illinois College of Medicine at Peoria , IL , USA ;
authors.forename: Minchul
authors.initials: M
authors.lastname: Kim
authors.affiliation: a Center for Outcomes Research, University of Illinois College of Medicine at Peoria , IL , USA ;|c University of Illinois College of Pharmacy at Chicago , IL , USA ;
authors.forename: Carl V
authors.initials: CV
authors.lastname: Asche
authors.affiliation: d Gastroenterology, O.S.F. Saint Francis Medical Center , Peoria , IL , USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Puli
mesh_terms: D000236:Adenoma / Q000453:epidemiology; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Cohort study; Colonoscopy; Colorectal cancer; Incidence; Screening