Improved physician ADR from a baseline of less than 26% linked to lower CRC risk
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Key takeaways:
- CRC incidence was lower among patients of physicians whose ADR improved from less than 26% at baseline.
- There was no difference in CRC incidence among patients whose physicians had a higher baseline ADR.
Improvement in adenoma detection rate among physicians with a baseline rate of less than 26% was significantly associated with decreased patient risk for colorectal cancer, according to results of an observational study conducted in Poland.
“An ADR of 25% to 35% is an accepted threshold indicating adequate ADRs by physicians,” Nastazja D. Pilonis, MD, PhD, of the department of gastroenterological oncology at Maria Sklodowska-Curie National Research Institute of Oncology, and colleagues wrote in JAMA. “However, the association of improved ADR across a wide range of ADRs at baseline with subsequent rates of CRC or CRC mortality in patients undergoing colonoscopy remains unclear.”
To better understand this association, Pilonis and colleagues used data from the Polish Colonoscopy Screening Program to identify 789 physicians who performed 485,615 screening colonoscopies (mean age of patients, 57 years; 60% women) between October 2000 and December 2017.
Researchers noted 73% of these physicians had an ADR “below the identified threshold of adequacy of 26%” at baseline. Median and maximum ADRs were 21.8% and 63%, respectively. During a median follow-up of 10.2 years, there were 1,873 post-colonoscopy diagnoses of CRC and 474 CRC-related deaths.
According to analysis, patients of physicians who improved their ADR from less than 26% at baseline demonstrated a post-colonoscopy CRC incidence of 31.8 (95% CI, 29.5-34.3) per 100,000 person-years, whereas those whose physicians did not improve had an incidence of 40.7 (95% CI, 37.8-43.8) per 100,000 person-years. This corresponded with a difference of 8.9 per 100,000 person-years between groups (95% CI, 5.06-12.74).
Researchers observed minimal difference in the incidence of post-colonoscopy CRC among patients of physicians with an ADR above 26% at baseline, whether or not there was improvement (23.4 vs. 22.5/100,000 person-years; difference = 0.9/100,000 person-years; 95% CI, –6.46 to 8.26).
“Among physicians with a baseline ADR of less than 26%, improvements in ADR over time were statistically significantly associated with lower CRC risk in their patients, compared with patients of physicians whose ADR did not improve,” Pilonis and colleagues wrote. “However, among physicians with a baseline ADR of 26% or higher, improvement in ADR over time was not associated with statistically significantly lower CRC risk in their patients.”
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