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Post-colonoscopy colorectal cancers in privately insured patients in South Africa
R Fourie1, D Bizos1, D Kruger1
1Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Background:
Post-colonoscopy colorectal cancers (PCCRCs) are colorectal cancers (CRCs) that are diagnosed within 3 - 5 years of a colonoscopy where a cancer was not detected. Colonoscopy is the current gold standard for the diagnosis of colorectal cancer. The rate of PCCRC is an indicator of the quality of colonoscopy, because the aim of a high-quality colonoscopy is to detect CRCs and advanced adenomas.
Objective:
To calculate the rate of PCCRC in a privately insured population in South Africa (SA).
Methods:
Data were retrospectively obtained from the largest private health insurance company in SA. Patients diagnosed with CRC from the period of 1 January 2013 to 31 December 2019 were included. Patients who were members of the fund for <5 years prior to diagnosis were excluded. Patients with conditions predisposing to CRC were excluded from the study. Patients with CRC who had undergone colonoscopy 6 - 60 months prior to the diagnosis of CRC were defined as PCCRC. Patients diagnosed with CRC were identified by ICD-10 codes and from the oncology registry. Colonoscopies were identified by procedure codes.
Results:
A diagnosis of CRC was made in 19 538 patients in the 7-year period. Following exclusions, 4 765 patients were included in this study for analysis. PCCRC was identified in 415 patients (8.72%) between 6 and 60 months, of whom 315 were identified between 6 and 36 months (6.61%). The median (interquartile range (IQR)) age in the overall study group presenting with CRC was 64 (53 - 73) years, with that of the PCCRC group (n=415) being higher at a median (IQR) age of 67(53 - 72) years when compared with the non-PCCRC group (n=4 350) of 64 (53 - 72) years (p=0.0002). Overall, 21.3% of CRC patients were aged ≤50 years, and 51.3% were male. The percentages of patients aged ≤50 years in the PCCRC v. non-PCCRC groups were 17.1% (n=71/415) and 21.7% (n=945/4 350), respectively (p=0.03). The gender ratio did not differ in the PCCRC group v. the non-PCCRC group. Rectal cancers were more likely to be present in the PCCRC group at 32.8% (n=136/415) v. the non-PCCRC group at 24% (n=1 043/4 350) (p<0.001). In the PCCRC subset, 73.8% of colonoscopies were performed by surgeons, 13.4% by gastroenterologists and 12.8% by physicians and general practioners/others. The PCCRC rate was 14.4% for gastroenterologists and 7.9% for surgeons.
Conclusion:
This study is the first study from SA to analyse PCCRC. The overall PCCRC rate was 6.61%, in line with published series.
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