title: Adenoma Detection Rates for Screening Colonoscopies in Smokers and Obese Adults: Data From the New Hampshire Colonoscopy Registry.
abstract: OBJECTIVE
  To examine screening adenoma detection rates (ADR) and serrated detection rates (SDR) among smokers and obese adults in the New Hampshire Colonoscopy Registry.
  
  
  BACKGROUND
  ADR, a quality measure for screening colonoscopies, is associated with protection from interval colorectal cancer. Currently, only sex-specific ADR benchmarks are reported. However, obesity and smoking ≥20 pack-years are strong predictors for colorectal neoplasia, as highlighted by the 2009 American College of Gastroenterology CRC Screening Guidelines. Data comparing ADR in smokers and obese adults to those without these risks are limited.
  
  
  METHODS
  We calculated ADR, SDR, and 95% confidence intervals for screening colonoscopies in participants ≥50 years. Sex-specific and sex-age-specific rates were compared by smoking exposure (never vs. <20 vs. ≥20 pack-years) and body mass index (<30 vs. ≥30).
  
  
  RESULTS
  A total of 21,539 screening colonoscopies were performed by 77 endoscopists at 20 facilities (April 2009 to September 2013). The difference in ADR between nonsmokers and smokers with ≥20 pack-years was 8.8% (P<0.0001) and between obesity groups 5.0% (P<0.0001). Significant sex-specific and sex-age-specific increases in ADR and SDR were found among smokers and obese participants.
  
  
  CONCLUSIONS
  ADR and SDR for smokers and obese adults were significantly higher than their counterparts without those risks. Endoscopists should consider the prevalence of these risks within their screening population when comparing their rates to established benchmarks. Calculating sex-specific or sex-age-specific ADR and SDR based on smoking and obesity may provide optimal protection for populations with a particularly high prevalence of smokers and obese adults.
authors.affiliation: *Department of Veterans Affairs Medical Center, White River Junction, VT †The Geisel School of Medicine at Dartmouth, Hanover ‡Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth §Department of Medicine ∥Section of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Anderson
authors.forename: Julia E
authors.initials: JE
authors.lastname: Weiss
authors.forename: Christina M
authors.initials: CM
authors.lastname: Robinson
authors.forename: Lynn F
authors.initials: LF
authors.lastname: Butterly
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000453:epidemiology; D000367:Age Factors; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009513:New Hampshire / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology*; D012042:Registries; D012737:Sex Factors; D000074285:Smokers / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology