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Who Needs Screening Colonoscopy?

Summary and Comment |
July 15, 2014

Who Needs Screening Colonoscopy?

  1. Douglas K. Rex, MD

A new predictive score might be helpful but falls short of adequately discriminating higher-risk from lower-risk patients in a screening population.

  1. Douglas K. Rex, MD

Multiple models have used predictive factors to identify patients at differing risks for colorectal cancer (CRC) with the aim of targeting colonoscopy to higher-risk groups and safer, less-costly modalities to lower-risk groups. Unfortunately, these models fail to achieve sufficient discrimination to be useful in clinical practice.

In the current study, investigators created a score to predict the risk for advanced neoplasia at screening colonoscopy. The study group comprised 35,918 participants (age range, 40 to 66 years; race, white) with advanced neoplasia (cancer or advanced adenomas) from a nationwide screening program in Poland. Traditional serrated adenomas, sessile serrated polyps or adenomas, and mixed serrated polyps were considered advanced if they were ≥10 mm in diameter.

From results of multivariate analysis, risk scores were assigned to each category of independent risk factor, as follows:

  • Age: 40–49 years=0, 50–54 years=1, 55–59 years=2, 60–66 years=3

  • Family history of CRC: none=0, one first-degree relative aged ≥60 years with CRC=1, one first-degree relative aged <60 years with CRC or two first-degree relatives with CRC=2

  • Gender: female=0, male=2

  • Smoking history: <10 pack-years=0, ≥10 pack-years=1

  • Body-mass index: <30 kg/m2=0, ≥30 kg/m2=1

The risks for advanced neoplasia associated with each score were: 1.32% (risk score, 0), 4.21% (1), 4.57% (2), 6.14% (3), 7.74% (4), 11.27% (5), 13.66% (6), and 19.12% (7 or 8).

Comment

These scores could be useful in helping patients decide what form of screening to utilize, but otherwise, as in previous studies, their discrimination value is insufficient for use in clinical practice. However, these authors join others who suggest that a risk score based on these factors that exceeds a certain level or a positive fecal immunochemical test could be used to identify patients who should undergo screening colonoscopy.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Given Imaging; Olympus Corporation America; Exact Sciences; Endo Aid Speaker’s bureau Boston Scientific; Braintree Laboratories; Ferring Pharmaceuticals; Olympus America Grant / Research support CDC; Olympus America; Boston Medical Center Editorial boards World Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Forces (AGA, ACG, ASGE) (Chair)

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