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Adenoma Detection Rate and Colorectal Cancer Risk in Fecal Immunochemical Test Screening Programs : An Observational
Manuel Zorzi1, Giulio Antonelli2, Claudio Barbiellini Amidei1
1Veneto Tumor Registry, Azienda Zero, Padova, Italy (M.Z., C.B.A., J.B.).
Annals of Internal Medicine
|February 21, 2023
Summary
Higher adenoma detection rates (ADR) in colonoscopies following positive fecal immunochemical tests (FITs) are linked to reduced postcolonoscopy colorectal cancer (PCCRC) risk. Improving endoscopist ADR is crucial for enhancing CRC screening program effectiveness.
Area of Science:
- Gastroenterology
- Oncology
- Public Health
Background:
- Fecal immunochemical tests (FITs) are standard for colorectal cancer (CRC) screening.
- Colonoscopy quality, measured by adenoma detection rate (ADR), impacts screening effectiveness.
- FIT positivity necessitates colonoscopy for neoplasia identification.
Purpose of the Study:
- To investigate the association between ADR and postcolonoscopy CRC (PCCRC) risk.
- To determine if colonoscopy quality influences CRC detection after a positive FIT.
- To inform quality improvement strategies in FIT-based CRC screening programs.
Main Methods:
- Retrospective population-based cohort study in northeastern Italy (2003-2021).
- Included patients with positive FIT results undergoing colonoscopy.
- Analyzed PCCRC diagnoses using Cox regression models, adjusting for ADR categories.
Main Results:
- A significant inverse association was found between ADR and PCCRC incidence risk.
- The lowest ADR group had a 2.35-fold higher PCCRC risk compared to the highest ADR group.
- Each 1% increase in ADR was associated with a 4% reduction in PCCRC risk (aHR=0.96).
Conclusions:
- Adenoma detection rate is inversely associated with PCCRC risk in FIT-based screening.
- Colonoscopy quality monitoring and improving endoscopists' ADR are essential.
- Higher ADR may significantly decrease PCCRC risk.
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