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Many Patients Do Not Receive Surveillance Colonoscopies Following a Diagnosis of High-Risk Adenomas

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Key Points

  • Patients who are diagnosed with high-risk adenomas following a colonoscopy screening often do not receive surveillance colonoscopies within the recommended 3-year time frame.
  • Patients diagnosed with ≥ 3 adenomas compared with 1 to 2 adenomas with villous/tubulovillous features were more likely to get a subsequent colonoscopy within the recommended time frame.
  • Patients aged 80 years and older at their index colonoscopy were less likely than younger patients to complete a subsequent colonoscopy.

A population-based study examining patient receipt of a surveillance colonoscopy 3 years after the removal of high-risk adeonomatous polyps has found that the procedure was underutilized and varied by health-care system, patient age, and number of adenomas found. Strategies to improve adherence to surveillance colonoscopy following the removal of advanced adenomas are needed, according to the study findings. The study by Chubak et al was published in Cancer Epidemiology, Biomarkers, & Prevention.

Colorectal cancer is the third most common cancer diagnosed in men and women in the United States. According to the American Cancer Society, more than 50,000 deaths from colorectal cancer will occur in 2018. To reduce the mortality rate from colorectal cancer, the U.S. Multi-Society Task Force on Colorectal Cancer recommends 3-year colonoscopies for patients with high-risk adenomatous polyps, including 3 to 10 tubular adenomas, any tubular adenoma ≥ 10 mm, any adenoma with villous histology, any adenoma with high-grade dysplasia, sessile serrated polyps ≥ 10 mm or with dysplasia, or traditional serrated adenoma.

Study Methodology

The study was conducted as part of the National Cancer Institute–funded Population-Based Research Optimizing Screening Through Personalized Regimens consortium. The researchers analyzed patterns and factors associated with subsequent colonoscopy among persons with at least three adenomas and/or at least one adenoma with villous/tubulovillous histology in four U.S. integrated health-care delivery systems.

The researchers analyzed data from 6,909 patients aged 50 to 89 years who had received a colonoscopy between January 1, 2010, and December 31, 2010, at which one or more high-risk adenomas were discovered. They used Kaplan-Meier estimators of the cumulative percentage of patients undergoing colonoscopy at 6 months to 3.5 years after an index colonoscopy with high-risk findings. Combining data from three health-care systems, the researchers used multivariable logistic regression with inverse probability of censoring weights to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between patient characteristics and the receipt of subsequent colonoscopy.

Study Results

The researchers found that among the 6,909 patients with advanced adenomas, the percentage receiving a subsequent colonoscopy 6 months to 3.5 years later ranged from 18.3% (95% CI = 11.7%–27.8%) to 59.5% (95% CI = 53.8%–65.2%) across the health-care systems. Differences remained significant in the multivariable model.

Patients with at least three adenomas were more likely than those with one or two villous/tubulovillous adenomas to undergo subsequent colonoscopy. Subsequent colonoscopy was also more common for patients aged 60 to 74 and less common for patients aged 80 to 89 compared with those aged 50 to 54 at their index colonoscopy.

Sex, race/ethnicity, and comorbidity index score were generally not associated with the receipt of subsequent colonoscopies.

Clinical Impact

“Strategies to improve adherence to surveillance colonoscopy following advanced adenomas are needed,” concluded the study authors.

“We encourage patients and health-care providers to talk about how and when to test for colorectal cancer, and we encourage health-care systems to find ways to support patients and providers in following the guidelines,” said Jessica Chubak, PhD, Senior Scientific Investigator at Kaiser Permanente Washington Health Research Institute and lead author of this study, in a statement. “In the future, it will be important to understand what types of reminders work best for different populations and in different health-care settings.”

Dr. Chubak is the corresponding author of this study.

Disclosure: Funding for this study was provided by the National Cancer Institute. See the study authors’ full disclosures at cepb.aacrjournals.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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