13-Year colorectal cancer risk after lower-quality, higher-quality and no screening colonoscopy: a cohort study

IF 7.3 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Journal of Clinical Epidemiology Pub Date : 2024-10-22 DOI:10.1016/j.jclinepi.2024.111571

Sarina Schwarz , Malte Braitmaier , Christian Pox , Bianca Kollhorst , Vanessa Didelez , Ulrike Haug

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引用次数: 0

Abstract

Objectives

A lower-quality colonoscopy has been shown to be less effective in reducing colorectal cancer (CRC) incidence than a higher-quality colonoscopy, but the comparison with no-screening colonoscopy (noSC) is lacking. We aimed to compare the 13-year risk of developing CRC between persons with I) a higher-quality screening colonoscopy (higherQualSC), II) a lower-quality screening colonoscopy (lowerQualSC), and III) without a screening colonoscopy.

Study Design and Setting

A health-care database (∼20% of the German population) was used to emulate a target trial with three arms: higherQualSC vs lowerQualSC vs noSC at baseline. The quality of screening colonoscopy was categorized based on the polyp detection rate of the examining physician (cut-off: 21.8%). We included persons aged 55–69 years at average CRC risk and CRC screening naïve at baseline. We estimated adjusted cumulative CRC incidence over 13 years of follow-up.

Results

The higherQualSC arm comprised 142,960 persons, the lowerQualSC arm 62,338 persons, and the noSC arm 124,040 persons. The adjusted 13-year CRC risk was 1.77% in the higherQualSC arm, 2.09% in the lowerQualSC arm, and 2.74% in the noSC arm. Compared to the noSC arm, the adjusted relative risk was 0.76 (95% CI: 0.70–0.84) in the lowerQualSC arm and 0.65 (95% CI: 0.60–0.69) in the higherQualSC arm.

Conclusion

Our study shows that a lowerQualSC is also effective in reducing CRC incidence compared to noSC. However, the effect is about one-third less than that of a higherQualSC.

查看原文本刊更多论文

低质量、高质量和未进行结肠镜筛查后的 13 年大肠癌风险：一项队列研究。

目的：与高质量的结肠镜检查相比，低质量的结肠镜检查在降低结肠直肠癌（CRC）发病率方面的效果较差，但缺乏与未进行结肠镜筛查的比较。我们的目的是比较 I）接受过质量较高的筛查结肠镜检查、II）接受过质量较低的筛查结肠镜检查和 III）未接受过筛查结肠镜检查的人群 13 年间罹患 CRC 的风险：利用医疗数据库（占德国总人口的 20%）来模拟一项目标试验，试验分为三个阶段：研究设计：使用一个医疗数据库（占德国总人口的 20%）模拟目标试验，试验分为三组：基线时进行高质量筛查结肠镜检查（higherQualSC） vs. 低质量筛查结肠镜检查（lowerQualSC） vs. 未进行筛查结肠镜检查（noSC）。筛查结肠镜检查的质量根据检查医生的息肉检出率进行分类（临界值：21.8%）。我们纳入了年龄在 55 岁至 69 岁之间、具有平均 CRC 风险且基线时未接受 CRC 筛查的人群。我们估算了 13 年随访期间调整后的累积 CRC 发病率：高QualSC组有142,960人，低QualSC组有62,338人，无QualSC组有124,040人。调整后的13年CRC风险在高QualSC组为1.77%，低QualSC组为2.09%，无QualSC组为2.74%。与无SC治疗组相比，低QualSC治疗组的调整后相对风险为0.76（95% CI：0.70-0.84），高QualSC治疗组的调整后相对风险为0.65（95% CI：0.60-0.69）：我们的研究表明，与不进行结肠镜筛查相比，低质量的结肠镜筛查也能有效降低 CRC 发病率。结论：我们的研究表明，与不进行结肠镜筛查相比，质量较低的结肠镜筛查也能有效降低 CRC 发病率，但其效果比质量较高的结肠镜筛查低约三分之一。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

12.00

自引率

6.90%

发文量

320

审稿时长

44 days

期刊介绍： The Journal of Clinical Epidemiology strives to enhance the quality of clinical and patient-oriented healthcare research by advancing and applying innovative methods in conducting, presenting, synthesizing, disseminating, and translating research results into optimal clinical practice. Special emphasis is placed on training new generations of scientists and clinical practice leaders.