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Higher Adenoma Detection Rates on Colonoscopy Linked to Lower Cancer Risk — Physician’s First Watch

Medical News |
April 3, 2014

Higher Adenoma Detection Rates on Colonoscopy Linked to Lower Cancer Risk

By the NEJM Journal Watch Editors, The

A strong inverse association exists between a colonoscopist's adenoma detection rate (ADR) and the risk for subsequent colorectal cancer, according to a retrospective study in the New England Journal of Medicine

Researchers identified some 265,000 colonoscopies undertaken in patients aged 50 and older in a regional healthcare system. During roughly 930,000 person-years of follow-up, 712 interval cancers occurred (defined as those diagnosed between 6 months and 10 years after colonoscopy). Colonoscopists' ADRs ranged from 7.4% to 52.5%.

Interval cancer risks, from the lowest to highest quintiles of ADRs, were 9.8, 8.6, 8.0, 7.0, and 4.8 cases per 10,000 person-years of follow-up. Patients of doctors in the highest ADR quintile had a 48% reduced risk for interval cancer (and a 62% reduction in risk for fatal cancer) compared with those in the lowest ADR quintile.

We should expect the impact of this study to be widespread and to include both increased demands for ADR measurement as well as increased expectations of higher minimum ADR thresholds as quality indicators.

Dr. Rex is an associate editor of NEJM Journal Watch Gastroenterology, from which this story was adapted.

Reader Comments (2)

Celeste taylor Physician, Gastroenterology

If you are sending patients to someone who has perforations you need to send them to another gastroenterologist.

Gordon Huth, MD

...and more colonic perforations as an unwanted side effect of colonoscopists attempting to increase their ADRs.

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