Interval cancer after colonoscopy in the Austrian National Screening Programme: influence of physician and patient factors
Autor: | Michael Trauner, D Penz, Elisabeth Waldmann, Monika Ferlitsch, Christoph Rinner, Hana Šinkovec, A Hinterberger, Georg Heinze, Lena Jiricka, B Majcher |
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Rok vydání: | 2020 |
Předmět: |
Adenoma
Male medicine.medical_specialty Time Factors Databases Factual Colorectal cancer Colonic Polyps Colonoscopy Lesion 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans 030212 general & internal medicine Early Detection of Cancer Aged medicine.diagnostic_test business.industry Incidence Incidence (epidemiology) Gastroenterology Middle Aged medicine.disease Tumor Burden Hyperplastic Polyp Dysplasia Austria Female 030211 gastroenterology & hepatology Clinical Competence Medical Record Linkage medicine.symptom Colorectal Neoplasms business Cohort study |
Zdroj: | Gut. 70:1309-1317 |
ISSN: | 1468-3288 0017-5749 |
Popis: | ObjectivePostscreening colorectal cancer (PSCRC) after screening colonoscopy is associated with endoscopists’ performance and characteristics of resected lesions. Prior studies have shown that adenoma detection rate (ADR) is a decisive factor for PSCRC, but correlations with other parameters need further analysis and ADR may change over time.DesignCohort study including individuals undergoing screening colonoscopy between 1/2008 and 12/2019 performed by physicians participating in a quality assurance programme in Austria. Data were linked with hospitalisation data for the diagnosis of PSCRC (defined as CRC diagnosis >6 months after colonoscopy). ADR was defined dynamically in relation to the time point of subsequent colonoscopies; high-risk groups of patients were those with an adenoma ≥10 mm, or with high-grade dysplasia, or villous or tubulovillous histology, or a serrated lesion ≥10 mm or with dysplasia, or colonoscopies with ≥3 lesions. Main outcome was PSCRC for each risk group (negative colonoscopy, hyperplastic polyps, low-risk and high-risk group of patients) after colonoscopy by endoscopists with an ADR Results352 685 individuals were included in the study (51.0% women, median age 60 years) of which 10.5% were classified as high-risk group. During a median follow-up of 55.4 months, 241 (0.06%) PSCRC were identified; of 387 participating physicians, 19.6% had at least one PSCRC (8.4% two or more). While higher endoscopist ADR decreased PSCRC incidence (HR per 1% increase 0.97, 95% CI 0.95 to 0.98), affiliation to the high-risk group of patients was also associated with higher PSCRC incidence (HR 3.27, 95% CI 2.36 to 4.00). Similar correlations were seen with regards to high-risk, and advanced adenomas. The risk for PSCRC was significantly higher after colonoscopy by an endoscopist with an ADR ConclusionA dynamic calculation of the ADR takes into account changes over time but confirms the correlation of ADR and interval cancer. Both lesion characteristics and endoscopists ADR may play a similar role for the risk of PSCRC. This should be considered in deciding about appropriate surveillance intervals in the future. |
Databáze: | OpenAIRE |
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