Yes, You Can! — Improve Your ADR and Reduce Your Patient's Colorectal Cancer Risk (So Why Are You Waiting?)

Summary and Comment |
May 15, 2017

Yes, You Can! — Improve Your ADR and Reduce Your Patient's Colorectal Cancer Risk (So Why Are You Waiting?)

  1. Douglas K. Rex, MD

The first study to directly link improvement in the adenoma detection rate to saving lives

  1. Douglas K. Rex, MD

The adenoma detection rate (ADR) is the percentage of patients aged ≥50 years undergoing screening colonoscopy who have one or more conventional adenomas detected. ADR is a validated quality measure for colonoscopy. In the current prospective study, researchers in Poland assessed whether ADR improvement reduces colorectal cancer (CRC) incidence and death.

ADR at baseline was divided into quintiles of ≤11.21%, 11.22–15.10%, 15.11–19.17%, 19.18–24.56%, and >24.56%. Improvement in ADR during the study period was defined as maintaining the highest quintile or advancing one quintile.

During a 6-year median follow-up of 146,860 patients, interval cancer (occurring after the screening colonoscopy and before the next scheduled colonoscopy) occurred in 168 patients and represented 10% of all detected colorectal cancers.

Seventy-five percent of physicians improved their ADRs. Reaching the highest ADR quintile and maintaining the highest ADR quintile reduced risks for cancer by 73% and 82%, respectively. After adjustments, ADR improvement was associated with reduced risks of 37% for CRC incidence and 50% for CRC death.

Comment

The current targets for ADR are 30% in men and 20% in women, or 25% for a typical mixed-gender patient population, and many U.S. endoscopists now exceed those minimum thresholds by a substantial margin. Additional study is needed to know how much improvement in cancer protection is gained by further increases in ADR, but it is unlikely that 25% is the optimum threshold.

This study is incredibly important, as it is the first demonstration that improvements in ADR prevent cancers and save lives. We now have ample evidence that ADR can be improved by training and education, by measurement, and by devices and techniques that improve mucosal exposure and highlight flat and depressed lesions. Measurement of ADR — and consideration of measures to improve it — are now integral and essential components of modern colonoscopy.

Note to readers: At the time NEJM Journal Watch reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Editor Disclosures at Time of Publication

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant/Advisory board Olympus Corporation America; Boston Scientific Speaker’s bureau Boston Scientific Grant/Research support Medtronic; Boston Scientific; Colonary Solutions; Paion Medical; Medivators; Braintree Laboratories 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; GI Journal Watch; Austin Journal of Gastroenterology; World Journal of Gastrointestinal Pharmacology & Therapeutics Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Force (AGA, ACG, ASGE) (Chair)

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