title: Factors Associated With Shorter Colonoscopy Surveillance Intervals for Patients With Low-Risk Colorectal Adenomas and Effects on Outcome.
abstract: Endoscopists do not routinely follow guidelines to survey individuals with low-risk adenomas (LRAs; 1-2 small tubular adenomas, < 1 cm) every 5-10 years for colorectal cancer; many recommend shorter surveillance intervals for these individuals. We aimed to identify the reasons that endoscopists recommend shorter surveillance intervals for some individuals with LRAs and determine whether timing affects outcomes at follow-up examinations.
  
  
  
  We collected data from 1560 individuals (45-75 years old) who participated in a prospective chemoprevention trial (of vitamin D and calcium) from 2004 through 2008. Participants in the trial had at least 1 adenoma, detected at their index colonoscopy, and were recommended to receive follow-up colonoscopy examinations at 3 or 5 years after adenoma identification, as recommended by the endoscopist. For this analysis we collected data from only participants with LRAs. These data included characteristics of participants and endoscopists and findings from index and follow-up colonoscopies. Primary endpoints were frequency of recommending shorter (3-year) vs longer (5-year) surveillance intervals, factors associated with these recommendations, and effect on outcome, determined at the follow-up colonoscopy.
  
  
  
  A 3-year surveillance interval was recommended for 594 of the subjects (38.1%). Factors most significantly associated with recommendation of 3-year vs a 5-year surveillance interval included African American race (relative risk [RR] to white, 1.41; 95% confidence interval [CI], 1.14-1.75), Asian/Pacific Islander ethnicity (RR to white, 1.7; 95% CI, 1.22-2.43), detection of 2 adenomas at the index examination (RR vs 1 adenoma, 1.47; 95% CI, 1.27-1.71), more than 3 serrated polyps at the index examination (RR=2.16, 95% CI, 1.59-2.93), or index examination with fair or poor quality bowel preparation (RR vs excellent quality, 2.16; 95% CI, 1.66-2.83). Other factors that had a significant association with recommendation for a 3-year surveillance interval included family history of colorectal cancer and detection of 1-2 serrated polyps at the index examination. In comparisons of outcomes, we found no significant differences between the 3-year vs 5-year recommendation groups in proportions of subjects found to have 1 or more adenomas (38.8% vs 41.7% respectively; P = .27), advanced adenomas (7.7% vs 8.2%; P = .73) or clinically significant serrated polyps (10.0% vs 10.3%; P = .82) at the follow-up colonoscopy.
  
  
  
  Possibly influenced by patients' family history, race, quality of bowel preparation, or number or size of polyps, endoscopists frequently recommend 3-year surveillance intervals instead of guideline-recommended intervals of 5 years or longer for individuals with LRAs. However, at the follow-up colonoscopy, similar proportions of participants have 1 or more adenomas, advanced adenomas, or serrated polyps. These findings support the current guideline recommendations of performing follow-up examinations of individuals with LRAs at least 5 years after the index colonoscopy.
authors.affiliation: Department of Medicine, Department of Veterans Affairs Medical Center, White River Junction, Vermont; Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Electronic address: joseph.anderson@dartmouth.edu.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Anderson
authors.affiliation: Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Medicine in the Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: John A
authors.initials: JA
authors.lastname: Baron
authors.affiliation: Department of Medicine in the Division of Gastroenterology and Hepatology, University of Colorado School of Medicine and Gastroenterology of the Rockies, Denver and Boulder, Colorado.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Ahnen
authors.affiliation: Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Barry
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, and Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Roberd M
authors.initials: RM
authors.lastname: Bostick
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Burke
authors.affiliation: Department of Medicine in the Division of Gastroenterology and Hepatology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Bresalier
authors.affiliation: Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Church
authors.affiliation: Interim Dean and Professor of Statistics in the College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont.
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Cole
authors.affiliation: Department of Medicine in the Division of Gastroenterology and Hepatology, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Marcia
authors.initials: M
authors.lastname: Cruz-Correa
authors.affiliation: Minnesota Gastroenterology, P.A., Minneapolis, Minnesota.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kim
authors.affiliation: Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Leila A
authors.initials: LA
authors.lastname: Mott
authors.affiliation: Department of Medicine in the Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.affiliation: Department of Medicine, Department of Veterans Affairs Medical Center, White River Junction, Vermont; Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Robertson
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control; D000368:Aged; D016588:Anticarcinogenic Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control; D003106:Colon / Q000473:pathology*; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control; D003113:Colonoscopy / Q000592:standards / Q000639:trends; D019587:Dietary Supplements; D018450:Disease Progression; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards / Q000639:trends; D005260:Female; D000072102:Gastroenterologists / Q000592:standards / Q000639:trends; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009656:North America; D016017:Odds Ratio; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D047368:Tumor Burden; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D016588:Anticarcinogenic Agents; D014807:Vitamin D; D002118:Calcium
keywords: Colon Cancer; Detection; Progression; Tumor Development