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Number of adenomas removed and colorectal cancers prevented in randomized trials of flexible sigmoidoscopy screening

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Title: Number of adenomas removed and colorectal cancers prevented in randomized trials of flexible sigmoidoscopy screening
Authors: Pinsky, PF
Loberg, M
Senore, C
Wooldrage, K
Atkin, W
Bretthauer, M
Cross, AJ
Hoff, G
Holme, O
Kalager, M
Segnan, N
Schoen, RE
Item Type: Journal Article
Abstract: Background & Aims Screening for colorectal cancer (CRC) with sigmoidoscopy reduces CRC incidence by detecting and removing adenomas. The number needed to screen is a measure of screening efficiency, but is not directly associated with adenoma removal. We propose 2 new metrics for quantifying the relationship between adenoma removal and CRC prevented: number of adenomas needed to remove (NNR) and adenoma dwell time avoided (DTA). Methods We collected data from 4 randomized trials of sigmoidoscopy screening (in the United States and 3 in Europe) to assess NNR and DTA. For each trial, NNR was computed as the number of adenomas removed from subjects in the intervention group divided by the number of CRCs prevented. DTA was computed similarly but taking into account the timing of adenoma removal. Combined results across trials were assessed using standard meta-analytic techniques. Results The estimated NNR for the PLCO trial was 74 (95% CI, 56–110), for the NORCCAP trial was 71 (95% CI, 44–174), for the SCORE trial was 27 (95% CI, 14–135), and for the UKFSST trial was 36 (95% CI, 28–52). The combined estimate (meta-analysis) of NNR was 52 (95% CI, 36–93) assuming heterogeneity (P for heterogeneity=.014). DTA estimates among trials ranged from 278 to 730 years, with a combined estimate of 500 years (95% CI, 344–833 years) assuming heterogeneity (P for heterogeneity=.035), or 2 CRC cases prevented per 1000 adenoma dwell years avoided. The combined estimates of NNR and DTA restricted to advanced adenomas were 13 (95% CI, 9–22) and 122 years (95% CI, 90–190), respectively. Conclusions We collected data from 4 randomized trials of sigmoidoscopy screening for CRC to develop metrics endoscopic efficiency, NNR and DTA, that are directly linked to adenoma detection and removal. They can be used to compare screening among endoscopic modalities and to more precisely measure adenoma to carcinoma transition rates.
Issue Date: 1-Oct-2018
Date of Acceptance: 18-Jun-2018
URI: http://hdl.handle.net/10044/1/61585
DOI: https://dx.doi.org/10.1053/j.gastro.2018.06.040
ISSN: 0016-5085
Publisher: Elsevier
Start Page: 1059
End Page: 1068.e2
Journal / Book Title: Gastroenterology
Volume: 155
Issue: 4
Copyright Statement: © 2018 by the AGA Institute. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: National Institute for Health Research
Cancer Research UK
Funder's Grant Number: HTA 16/65/01
25004
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Efficiency of Screening
Early Detection
Colon Cancer
Tumor
COLONOSCOPY
Colon Cancer
Early Detection
Efficiency of Screening
Tumor
Adenoma
Aged
Cell Transformation, Neoplastic
Colorectal Neoplasms
Decision Support Techniques
Early Detection of Cancer
Europe
Female
Humans
Incidence
Male
Middle Aged
Numbers Needed To Treat
Predictive Value of Tests
Prognosis
Randomized Controlled Trials as Topic
Risk Factors
Sigmoidoscopy
Time Factors
United States
Humans
Adenoma
Colorectal Neoplasms
Cell Transformation, Neoplastic
Sigmoidoscopy
Prognosis
Incidence
Risk Factors
Predictive Value of Tests
Decision Support Techniques
Time Factors
Aged
Middle Aged
United States
Europe
Female
Male
Randomized Controlled Trials as Topic
Early Detection of Cancer
Numbers Needed To Treat
1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
1109 Neurosciences
Gastroenterology & Hepatology
Publication Status: Published
Online Publication Date: 2018-06-20
Appears in Collections:Division of Surgery
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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