Interval colorectal cancer. Review and retrospective analysis of the regional colon cancer screening program in terms of risk factors and colonoscopy quality indicators
Abstract
Retrospective evaluation of the results of the regional colon cancer screening program, performed on the basis of the Tyumen Regional Oncological Dispensary (currently "Medical City") and medical institutions in Tyumen and the south of the Tyumen region in the period 2016-2018.
MATERIALS AND METHODS: the regional colon cancer screening program consists of two phases. At the first stage, in medical institutions of the city of Tyumen and the south of the Tyumen region, patients aged 40-65 years old underwent a fecal immunochemical test. At stage 2, patients with a positive fecal occult blood test are routed to medical institutions in the city of Tyumen and the south of the Tyumen region for screening colonoscopy.
RESULTS: in 2016 - 2018 at the first stage, a fecal immunochemical test was performed on 251847 people. Of these, with a positive fecal immunochemical test for occult blood, 22249 screening studies were performed by colonoscopy for patients aged 40–65 years in the endoscopy department of the Tyumen Cancer Center and medical institutions in the city of Tyumen and the south of the Tyumen region. Colonoscopy was performed in 4396 patients on the basis of the Tyumen Cancer Center, and 17853 people were examined in the general medical network. Colonoscopy revealed adenomas and adenocarcinomas of the large intestine in 4025 (ADR=18%) patients. In the oncological dispensary, adenomas and adenocarcinomas of the colon were detected in 1264 people, and in medical institutions in the city of Tyumen and the south of the Tyumen region in 2761 people. Adenoma detection rate in the oncological dispensary was 25.5%, and in medical institutions in the city of Tyumen and the south of the Tyumen region 12.4%. Out of 4396 people who performed a screening study of the colon in the "Medical City" in the 6-year follow-up period 2016-2021. Identified 8 people with PСCRC, which is 0.2% of cases classified as interval CRC. In 3 out of 8 cases, interval CRC was localized in the right colon.
CONCLUSION: prognostically, in 2338 cases of screening colonoscopies performed in medical institutions in the city of Tyumen and the south of the Tyumen region, adenomas and adenocarcinomas were not detected, based on the proper 25% detection rate.
About the Author
Evgeny N. DesyatovRussian Federation
References
1. Malignant neoplasms in Russia in 2020 (morbidity and mortality). Edited by A.D. Kaprin, V.V. Starinsky, A.O. Shakhzadova – M.: P.A. Herzen Moscow State Medical Research Institute − Branch of the Federal State Budgetary Institution "NMIC of Radiology" of the Ministry of Health of Russia. 2021; fig., 252 p. (in Russ.).
2. Baxter NN, et al. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology. 2011 Jan;140(1):65-72. doi: 10.1053/j.gastro.2010.09.006. Epub 2010 Sep 18.
3. Sanduleanu S, et al. Expert Working Group on ‘Right-sided lesions and interval cancers’. Colorectal Cancer Screening Committee, World Endoscopy Organization. Gut. 2015 Aug; 64(8): 1257-67. doi: 10.1136/gutjnl-2014-307992.
4. Douglas AC, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014; 370: 1298–1306.
5. Haseman JH, et al. Failure of colonoscopy to detect colorectal cancer: evaluation of 47 cases in 20 hospitals. Gastrointest Endosc. 1997;45(06):451–455. doi: 10.1016/s0016-5107(97)70172-x
6. Masclee AM, Meijer GA, Sanduleanu S. Interval cancers after colonoscopy-insights and recommendations. Nat Rev Gastroenterol Hepatol. 2012;9(09):550–554. doi: 10.1038/nrgastro.2012.136.
7. Murad MH, et al. Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis. Am J Gastroenterol. 2014; 109(09):1375–1389. doi: 10.1038/ajg.2014.171
8. Brenner H, et al. Does a negative screening colonoscopy ever need to be repeated? Gut. 2006; 55(08):1145–1150. doi: 10.1136/gut.2005.087130.
9. Brenner H, et al. Interval cancers after negative colonoscopy: population-based case-control study. Gut. 2012;61(11):1576–1582. doi: 10.1136/gutjnl-2011-301531
10. Farrar WD, et al. Microsatellite instability in interval colon cancers. Gastroenterology. 2006; 131(06):1700–1705. doi: 10.1053/j.gastro.2006.10.022.
11. Nishihara R, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013; 369(12):1095–1105. doi: 10.1056/NEJMoa1301969.
12. Mustafa A Arain, et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol. 2010; 105(05):1189–1195. doi: 10.1038/ajg.2009.699.
13. Rex DK, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997; 112(1):24–8. doi: 10.1016/s0016-5085(97)70214-2.
14. Singh H, et al. Rateand predictors of early/missed colorectal cancer safter colonoscopy in Manitoba: a population-based study. Am J Gastroenterol. 2010;105(12): 2588–2596. doi: 10.1038/ajg.2010.390.
15. Millan MS, et al. Adenoma detection rate: the real indicator of quality in colonoscopy. Dis Colon Rectum. 2008; 51(8):1217–20. doi: 10.1007/s10350-008-9315-3.
16. Kaminski MF, et al. Increased rate of adenoma detection associates with reduced risk of colorectal Cancer and death. Gastroenterology. 2017; 153(01):98–105. doi: 10.1053/j.gastro.2017.04.006.
17. Hoff G, Holme O, Bretthauer M, et al. Cecum intubation rate as quality indicator in clinical versus screening colonoscopy. Endosc Int Open. 2017; 5(6): E489–95. doi: 10.1055/s-0043-106180
18. Hilsden RJ, et al. The association of colonoscopy quality indicators with the detection of screen-relevant lesions, adverse events, and post colonoscopy cancers in an asymptomatic Canadian colorectal cancer screening population. Gastrointest Endosc. 2015;82(05):887–894. doi: 10.1016/j.gie.2015.03.1914.
19. Anderson JC, Butterly LF. Colonoscopy: quality indicators. Clin Transl Gastroenterol. 2015 Feb 26;6(2):e77. doi: 10.1038/ctg.2015.5.
20. Gellad ZF, et al. Colonoscopy withdrawal time and risk of neoplasia at 5 years: results from VA Cooperative Studies Program 380. Am J Gastroenterol. 2010;105(08):1746–1752. doi: 10.1038/ajg.2010.107
21. Van Heijningen EMB, et al. Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study. Gut. 2015;64(10): 1584–1592. doi: 10.1136/gutjnl-2013-306453
22. Tutticci NJ, Hewett DG, Leggett BA. Prevalence of serrated polyps: implications for significance as colorectal cancer precursors. Colorectal Cancer. 2013; 2:535–547 27 Nov 2013. https://doi.org/10.2217/crc.13.70
23. Anderson JC, et al. Higher Serrated Detection Rate Is Associated With Lower Risk for Post Colonoscopy Colorectal Cancer. Am J Gastroenterology. 114():p S137, October 2019. doi: 10.14309/01.ajg.0000590468.56713.85
24. Petri A., Sabin K. Visual medical statistics: studies.the manual. (translated from English. Edited by V.P. Leonov. 3rd ed., reprint. and additional). GEOTAR-Media, 2015; 216 p.: ill. (in Russ.).
25. Bond JH. Polyp guideline: diagnosis, treatment and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroent. 2000 Nov; 95(11):3053-63. doi: 10.1111/j.1572-0241
26. Deenadayalu VP, Chadalawada V, Rex DK. 170 degrees wide-angle colonoscope: effect on efficiency and miss rates. Am J Gastroenterol. 2004 Nov; 99(11):2138-42.
27. Waldmann E, et al. Endoscopists with low adenoma detection rates benefit from high-definition endoscopy. Surg Endosc. 2015; 29:466–473. doi: 10.1007/s00464-014-3688-2.
28. Saikaly E., Saad MK. Postcolonoscopy Colorectal Cancer: An Overview and Future Directions. Journal of Coloproctology. 2021; 41(03): 301-307. doi: 10.1055/s-0041-1730014
29. Easy Fisher exact test calculator. https://www.socscistatistics.com/tests/fisher/default2.aspx //
Review
For citations:
Desyatov E.N. Interval colorectal cancer. Review and retrospective analysis of the regional colon cancer screening program in terms of risk factors and colonoscopy quality indicators. Koloproktologia. 2023;22(2).
JATS XML
Email this article 
