For a study, researchers sought to determine the relationship between physician adenoma detection rate values and post colonoscopy colorectal cancer risks and associated fatalities.
The retrospective cohort study included 43 endoscopy centers, 383 eligible physicians, and 735,396 patients aged 50 to 75 years who received a colonoscopy that did not detect cancer (negative colonoscopy) between January 2011 and June 2017 with patient follow-up through December 2017. Each patient’s physician’s adenoma detection rate is based on screening tests performed in the calendar year before the patient’s negative colonoscopy. In statistical analysis, the adenoma detection rate was defined as a continuous variable and was dichotomized as at or above versus below the median in descriptive analyses. Colorectal adenocarcinoma diagnosed at least 6 months after any negative colonoscopy was the primary outcome (post colonoscopy colorectal cancer) (all indications). Death from post colonoscopy colorectal cancer was one of the secondary outcomes.
About 440,352 (51.6%) of the 735,396 patients who had 852,624 negative colonoscopies were female patients, the median patient age was 61.4 years (IQR, 55.5-67.2 years), the median follow-up per patient was 3.25 years (IQR, 1.56-5.01 years), and there were 619 post colonoscopy colorectal cancers and 36 related deaths during more than 2.4 million person-years of follow-up. Across a wide range of adenoma detection rate values, patients of physicians with higher adenoma detection rates had significantly lower risks for post colonoscopy colorectal cancer (hazard ratio [HR], 0.97 per 1% absolute adenoma detection rate increase [95% CI, 0.96-0.98]) and death from post colonoscopy colorectal cancer (HR, 0.95 per 1% absolute adenoma detection rate increase [95% CI, 0.92-0.99]) across a broad range of adenoma detection rate values, with no interaction by sex (P value for interaction = .18). When compared to adenoma detection rates below the median of 28.3%, detection rates at or above the median were associated with a lower risk of postcolonoscopy colorectal cancer (1.79 vs 3.10 cases per 10,000 person-years; absolute difference in 7-year risk, 12.2 per 10,000 negative colonoscopies [95% CI, 10.3 to 13.4]; HR, 0.61 [95% CI, 0.52-0.73]) and related deaths (0.05 vs 0.22 cases per 10,000 person-years; absolute difference in 7-year risk, −1.2 per 10,000 negative colonoscopies [95%, CI, −0.80 to −1.69]; HR, 0.26 [95% CI, 0.11-0.65]).
Colonoscopies performed by physicians with greater adenoma detection rates were substantially related with decreased risks of postcolonoscopy colorectal cancer over a wide range of adenoma detection rate values in three major community-based settings. These data may aid in the development of recommended objectives for colonoscopy quality measurements.