In a retrospective cohort study reported in JAMA, Schottinger et al found that patients treated by physicians with higher adenoma detection rates on colonoscopies negative for cancer had a lower risk of postcolonoscopy colorectal cancer and death from colorectal cancer.
Study Details
The study included 735,396 patients aged 50 to 75 years who had 852,624 colonoscopies negative for cancer in the Kaiser Permanente Northern California, Kaiser Permanente Southern California, and Kaiser Permanente Washington integrated health-care systems between January 2011 and June 2017. The analysis included 383 physicians who performed at least 100 total colonoscopies and at least 25 screening colonoscopies per year. Among physicians, adenoma detection rates ranged from less than 20% to 50% or higher.
Key Findings
Median follow-up per patient was 3.25 years (interquartile range = 1.56–5.01 years). A total of 619 patients developed postcolonoscopy colorectal cancer, and 36 patients died from colorectal cancer during more than 2.4 million person-years of follow-up.
With adenoma detection rate analyzed as a continuous variable, patients of physicians with higher adenoma detection rates had significantly lower risks for postcolonoscopy colorectal cancer (hazard ratio [HR] per 1% absolute adenoma detection rate increase = 0.97, 95% confidence interval [CI] = 0.96–0.98) and death from colorectal cancer (HR per 1% absolute adenoma detection rate increase = 0.95, 95% CI = 0.92–0.99).
Median adenoma detection rate among physicians was 28.3%. Compared with patients of physicians with detection rates below the median, patients of physicians with detection rates at or above the median had significantly lower risks of postcolonoscopy colorectal cancer (1.79 vs 3.10 cases per 10,000 person-years; absolute difference in 7-year risk = −12.2, 95% CI = −10.3 to −13.4, per 10,000 negative colonoscopies; HR = 0.61, 95% CI = 0.52–0.73) and death from colorectal cancer (0.05 vs 0.22 cases per 10,000 person-years; absolute difference in 7-year risk = −1.2, 95% CI = −0.80 to −1.69, per 10,000 negative colonoscopies; HR = 0.26, 95% CI = 0.11–0.65).
The investigators concluded, “Within three large community-based settings, colonoscopies by physicians with higher adenoma detection rates were significantly associated with lower risks of postcolonoscopy colorectal cancer across a broad range of adenoma detection rate values. These findings may help inform recommended targets for colonoscopy quality measures.”
Douglas A. Corley, MD, PhD, of the Division of Research, Kaiser Permanente, Oakland, CA, is the corresponding author for the JAMA article.
Disclosure: The study was funded by the National Cancer Institute PROSPR II consortium. For full disclosures of the study authors, visit jamanetwork.com.
