title: Incidence of advanced neoplasia during surveillance in high- and intermediate-risk groups of the European colorectal cancer screening guidelines.
abstract: Background and study aims:The European guidelines for quality assurance in colorectal cancer (CRC) screening have established high-risk (≥ 5 adenomas or an adenoma ≥ 20 mm) and intermediate-risk (3 - 4 adenomas or at least one adenoma 10 - 19 mm in size, or villous histology, or high grade dysplasia) groups with different endoscopic surveillance intervals. The aim of this study was to evaluate the difference in the incidence of advanced neoplasia (advanced adenoma or CRC) between the two risk groups.Patients and methods:This retrospective group study included patients meeting high- or intermediate-risk criteria for adenomas detected in CRC screening programs and the COLONPREV study before European guidelines were adopted in Spain (June 2011) with a 3-year surveillance recommendation according to Spanish guidelines. The primary outcome measure was the incidence of advanced neoplasia in patients undergoing surveillance. The secondary outcome measure was the CRC incidence. We used an adjusted proportional hazards regression model to control confounding variables.Results:The study included 5401 patients (3379 intermediate risk, 2022 high risk). Endoscopic surveillance was performed in 65.5 % of the patients (2.8 ± 1 years). The incidence of advanced neoplasia in the high- and intermediate-risk groups was 16.0 % (59.0 cases/1000 patient-years) and 12.3 % (41.2 cases/1000 patient-years), respectively. The CRC incidence was 0.5 % (1.4 cases/1000 patient-years) and 0.4 % (1 case/1000 patient-years), respectively. The advanced neoplasia and CRC attributable risk to the high risk group was of 3.7 % and 0.1 %, respectively. In the proportional hazards analysis, the risk of advanced neoplasia was greater in the high-risk group (hazard ratio [HR] 1.5, 95 % confidence interval [CI] 1.2 - 1.8), with no significant differences in the CRC incidence (HR 1.6, 95 %CI 0.6 - 3.8).Conclusions:Patients meeting high-risk criteria have a higher incidence of advanced neoplasia during endoscopic surveillance. No differences were found in the CRC incidence at a 3-year surveillance recommendation.
authors.affiliation: Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra and Vigo, Ourense, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Cubiella
authors.affiliation: Unidad de Gestión Clínica de Digestivo, IMIB Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Carballo
authors.affiliation: Colorectal Cancer Screening Programme Coordinating Centre, Basque Health Service, Bizkaia, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Portillo
authors.affiliation: Programa de Cribado de Cáncer Colorrectal de la Región de Murcia, IMIB Arrixaca, Servicio Murciano de Salud, Murcia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Cruzado Quevedo
authors.affiliation: Programa Poblacional de Cribado de Cáncer Colorrectal, Dirección General de Salud Pública, Conselleria de Sanitat, Valencia, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Salas
authors.affiliation: Programa de Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Binefa
authors.affiliation: Programa de Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Milà
authors.affiliation: Servicio de Epidemiología y Evaluación, Parc de Salut Mar, IMIM, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Hernández
authors.affiliation: Servicio de Gastroenterología, Parc de Salut Mar, IMIM, Barcelona, Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Andreu
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Terán
authors.affiliation: BioCruces, Hospital Universitario Cruces, Bizkaia, Spain.
authors.forename: Eunate
authors.initials: E
authors.lastname: Arana-Arri
authors.affiliation: Unidad de Gestión Clínica de Digestivo, IMIB Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ono
authors.affiliation: Programa de Cribado de Cáncer Colorrectal de la Región de Murcia, IMIB Arrixaca, Servicio Murciano de Salud, Murcia, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Valverde
authors.affiliation: Servicio de Gastroenterología, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Bujanda
authors.affiliation: Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Ourense, Pontevedra and Vigo, Vigo, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Hernández
authors.affiliation: Servicio de Gastroenterología, Hospital Clínico Universitario San Carlos, Madrid, Spain.
authors.forename: Juan Diego
authors.initials: JD
authors.lastname: Morillas
authors.affiliation: Unidad de Gastroenterología, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jover
authors.affiliation: Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Castells
mesh_terms: D000236:Adenoma / Q000453:epidemiology* / Q000473:pathology*; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D055088:Early Detection of Cancer / Q000592:standards; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D047368:Tumor Burden