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Higher adenoma detection rates at screening associated with lower long-term colorectal cancer incidence and mortality

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Title: Higher adenoma detection rates at screening associated with lower long-term colorectal cancer incidence and mortality
Authors: Cross, A
Robbins, E
Saunders, B
Duffy, SW
Wooldrage, K
Item Type: Journal Article
Abstract: Background and Aims Detection and removal of adenomas reduces colorectal cancer (CRC) risk. The impact of adenoma detection rates (ADRs) on long-term CRC incidence and mortality is unknown. We investigated this using data from the UK Flexible Sigmoidoscopy Screening Trial (UKFSST). Methods Of 167,882 UKFSST participants, 40,085 were in the intervention arm and underwent flexible sigmoidoscopy screening at 13 trial centres. Median follow-up was 17 years. At each centre, one endoscopist performed most flexible sigmoidoscopies. Multivariable logistic regression was used to classify centres into high-, intermediate-, and low-detector groups based on their main endoscopist’s ADR. We calculated incidence and mortality of distal and all-site CRC, and estimated hazard ratios (HRs) with 95% confidence intervals (CIs) using Cox regression. Results Five, four, and four centres, respectively, were classified into the high-detector, intermediate-detector, and low-detector groups. Average ADRs in each respective group were 15%, 12%, and 9%. Distal CRC incidence and mortality were reduced among those screened compared to controls in all groups, and effects of screening varied significantly by detector ranking, with larger reductions in incidence and mortality seen in the high-detector (incidence: HR=0·34, 0·27–0·42; mortality: HR=0·22, 0·13–0·37) than low-detector group (incidence: HR=0·55, 0·44–0·68; mortality: HR=0·54, 0·34–0·86). Similar results were observed for all-site CRC, with larger effects seen in the high-detector (incidence: HR=0·58, 95%CI 0·50–0·67; mortality: HR=0·52, 0·39–0·69) than low-detector group (incidence: HR=0·72, 0·61–0·85; mortality: HR=0·68, 0·51–0·92), although the heterogeneity was not statistically significant. Conclusions Higher ADRs at screening provide greater long-term protection against CRC incidence and mortality.
Issue Date: 1-Feb-2022
Date of Acceptance: 10-Sep-2020
URI: http://hdl.handle.net/10044/1/83424
DOI: 10.1016/j.cgh.2020.09.020
ISSN: 1542-3565
Publisher: Elsevier
Start Page: e148
End Page: e67
Journal / Book Title: Clinical Gastroenterology and Hepatology
Volume: 20
Issue: 2
Copyright Statement: © 2020 by the AGA Institute. The accepted manuscript is published online under a CC-BY Attribution Licence 4.0 (https://creativecommons.org/licenses/by/4.0/)
Sponsor/Funder: National Institute for Health Research
Cancer Research UK
Funder's Grant Number: HTA 16/65/01
Keywords: Adenoma Detection Rate
Colorectal Cancer
Flexible Sigmoidoscopy
Gastroenterology & Hepatology
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2020-09-12
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine
School of Public Health

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