Cited by 2,270Colorectal Cancer Screening and DetectionColorectal Cancer Surgical TreatmentsGlobal Cancer Incidence and Screening

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Adenoma Detection Rate and Risk of Colorectal Cancer and Death

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Corley, Douglas A., Jensen, Christopher D., Marks, Amy R., Zhao, Wei K., Lee, Jeffrey K., Doubeni, Chyke A., Zauber, Ann G., de Boer, Jolanda, Fireman, Bruce H., Schottinger, Joanne E., Quinn, Virginia P., Ghai, Nirupa R., Levin, Theodore R., Quesenberry, Charles P.·2014·New England Journal of Medicine

DOI 10.1056/nejmoa1309086PMC PMC4036494

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Abstract

BACKGROUND: The proportion of screening colonoscopic examinations performed by a physician that detect one or more adenomas (the adenoma detection rate) is a recommended quality measure. However, little is known about the association between this rate and patients' risks of a subsequent colorectal cancer (interval cancer) and death. METHODS: Using data from an integrated health care delivery organization, we evaluated the associations between the adenoma detection rate and the risks of colorectal cancer diagnosed 6 months to 10 years after colonoscopy and of cancer-related death. With the use of Cox regression, our estimates of attributable risk were adjusted for the demographic characteristics of the patients, indications for colonoscopy, and coexisting conditions. RESULTS: We evaluated 314,872 colonoscopies performed by 136 gastroenterologists; the adenoma detection rates ranged from 7.4 to 52.5%. During the follow-up period, we identified 712 interval colorectal adenocarcinomas, including 255 advanced-stage cancers, and 147 deaths from interval colorectal cancer. The unadjusted risks of interval cancer according to quintiles of adenoma detection rates, from lowest to highest, were 9.8, 8.6, 8.0, 7.0, and 4.8 cases per 10,000 person-years of follow-up, respectively. Among patients of physicians with adenoma detection rates in the highest quintile, as compared with patients of physicians with detection rates in the lowest quintile, the adjusted hazard ratio for any interval cancer was 0.52 (95% confidence interval [CI], 0.39 to 0.69), for advanced-stage interval cancer, 0.43 (95% CI, 0.29 to 0.64), and for fatal interval cancer, 0.38 (95% CI, 0.22 to 0.65). Each 1.0% increase in the adenoma detection rate was associated with a 3.0% decrease in the risk of cancer (hazard ratio, 0.97; 95% CI, 0.96 to 0.98). CONCLUSIONS: The adenoma detection rate was inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer. (Funded by the Kaiser Permanente Community Benefit program and the National Cancer Institute.).

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Authors: Corley, D. A., Jensen, C. D., Marks, A. R., Zhao, W. K., Lee, J. K., Doubeni, C. A., Zauber, A. G., de Boer, J., Fireman, B. H., Schottinger, J. E., Quinn, V. P., Ghai, N. R., Levin, T. R., & Quesenberry, C. P.
Affiliations: Kaiser Permanente (US)
University of Pennsylvania (US)
Memorial Sloan Kettering Cancer Center (US)
ORCID: Corley, Douglas A.
Jensen, Christopher D.
Marks, Amy R.
Zhao, Wei K.
Lee, Jeffrey K.
Doubeni, Chyke A.
Zauber, Ann G.
Fireman, Bruce H.
Schottinger, Joanne E.
Quinn, Virginia P.
Ghai, Nirupa R.
Levin, Theodore R.
Quesenberry, Charles P.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2014-04-03
Volume: 370
Issue: 14
Pages: 1298-1306
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1309086
PMC: PMC4036494
OpenAlex: W2111147183
Semantic Scholar: e0cb208735832bc600fef49a5303a037928bd5e6
Cited by: 2,270
References: 44
Citations by year: 2026: 164 · 2025: 211 · 2024: 198 · 2023: 211 · 2022: 224 · 2021: 218 · 2020: 217 · 2019: 187 · 2018: 177 · 2017: 145 · 2016: 126 · 2015: 126 · 2014: 59
FWCI: 73.28
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5u01ca151736-06)
National Cancer Institute (U01 CA-151736, U54CA163262, U24CA171524, P30CA008748)
National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007007)
Topics: Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords: adenoma detection rate, colonoscopy, colorectal cancer, interval cancer, colorectal cancer mortality, advanced colorectal cancer, colonoscopy quality, colorectal adenocarcinoma, gastroenterologists
MeSH terms: Adenoma, Aged, Colonoscopy, Humans, Middle Aged, Risk, United States, Colorectal Neoplasms

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