Detecting Advanced Colorectal Neoplasia at Colonoscopy
Detecting Advanced Colorectal Neoplasia at Colonoscopy
Objective. This study aimed to develop and validate a model to estimate the likelihood of detecting advanced colorectal neoplasia in Caucasian patients.
Design. We performed a cross-sectional analysis of database records for 40-year-old to 66-year-old patients who entered a national primary colonoscopy-based screening programme for colorectal cancer in 73 centres in Poland in the year 2007. We used multivariate logistic regression to investigate the associations between clinical variables and the presence of advanced neoplasia in a randomly selected test set, and confirmed the associations in a validation set. We used model coefficients to develop a risk score for detection of advanced colorectal neoplasia.
Results. Advanced colorectal neoplasia was detected in 2544 of the 35,918 included participants (7.1%). In the test set, a logistic-regression model showed that independent risk factors for advanced colorectal neoplasia were: age, sex, family history of colorectal cancer, cigarette smoking (p<0.001 for these four factors), and Body Mass Index (p=0.033). In the validation set, the model was well calibrated (ratio of expected to observed risk of advanced neoplasia: 1.00 (95% CI 0.95 to 1.06)) and had moderate discriminatory power (c-statistic 0.62). We developed a score that estimated the likelihood of detecting advanced neoplasia in the validation set, from 1.32% for patients scoring 0, to 19.12% for patients scoring 7–8.
Conclusions. Developed and internally validated score consisting of simple clinical factors successfully estimates the likelihood of detecting advanced colorectal neoplasia in asymptomatic Caucasian patients. Once externally validated, it may be useful for counselling or designing primary prevention studies.
The strength of evidence regarding the efficacy of colorectal cancer screening in reducing the incidence of colorectal cancer and associated mortality is increasing. Colorectal cancer screening is currently recommended in the European Union; however, adherence to this recommendation is not sufficient. One of the most important barriers to screening is a lack of perceived risk of colorectal cancer among average-risk patients and primary care providers. The risk of colorectal cancer or advanced colorectal neoplasia varies with regard to several factors, including age, sex, family history of colorectal cancer, smoking, obesity, diabetes mellitus, long-term non-steroid anti-inflammatory drug use, diet and physical activity. Information about some of these factors is easy to obtain and could be used to indentify patients at high-average risk of advanced colorectal neoplasia who are likely to benefit the most from screening. This high-average risk population should be the target of most intensive participation improvement interventions and primary prevention studies.
We performed a cross-sectional analysis of data from a national colonoscopy screening programme to derive and validate a risk prediction model for detection of advanced colorectal neoplasia. The results of the model were used to develop a simple scoring system that estimates the likelihood of detecting advanced colorectal neoplasia in asymptomatic patients.
Abstract and Introduction
Abstract
Objective. This study aimed to develop and validate a model to estimate the likelihood of detecting advanced colorectal neoplasia in Caucasian patients.
Design. We performed a cross-sectional analysis of database records for 40-year-old to 66-year-old patients who entered a national primary colonoscopy-based screening programme for colorectal cancer in 73 centres in Poland in the year 2007. We used multivariate logistic regression to investigate the associations between clinical variables and the presence of advanced neoplasia in a randomly selected test set, and confirmed the associations in a validation set. We used model coefficients to develop a risk score for detection of advanced colorectal neoplasia.
Results. Advanced colorectal neoplasia was detected in 2544 of the 35,918 included participants (7.1%). In the test set, a logistic-regression model showed that independent risk factors for advanced colorectal neoplasia were: age, sex, family history of colorectal cancer, cigarette smoking (p<0.001 for these four factors), and Body Mass Index (p=0.033). In the validation set, the model was well calibrated (ratio of expected to observed risk of advanced neoplasia: 1.00 (95% CI 0.95 to 1.06)) and had moderate discriminatory power (c-statistic 0.62). We developed a score that estimated the likelihood of detecting advanced neoplasia in the validation set, from 1.32% for patients scoring 0, to 19.12% for patients scoring 7–8.
Conclusions. Developed and internally validated score consisting of simple clinical factors successfully estimates the likelihood of detecting advanced colorectal neoplasia in asymptomatic Caucasian patients. Once externally validated, it may be useful for counselling or designing primary prevention studies.
Introduction
The strength of evidence regarding the efficacy of colorectal cancer screening in reducing the incidence of colorectal cancer and associated mortality is increasing. Colorectal cancer screening is currently recommended in the European Union; however, adherence to this recommendation is not sufficient. One of the most important barriers to screening is a lack of perceived risk of colorectal cancer among average-risk patients and primary care providers. The risk of colorectal cancer or advanced colorectal neoplasia varies with regard to several factors, including age, sex, family history of colorectal cancer, smoking, obesity, diabetes mellitus, long-term non-steroid anti-inflammatory drug use, diet and physical activity. Information about some of these factors is easy to obtain and could be used to indentify patients at high-average risk of advanced colorectal neoplasia who are likely to benefit the most from screening. This high-average risk population should be the target of most intensive participation improvement interventions and primary prevention studies.
We performed a cross-sectional analysis of data from a national colonoscopy screening programme to derive and validate a risk prediction model for detection of advanced colorectal neoplasia. The results of the model were used to develop a simple scoring system that estimates the likelihood of detecting advanced colorectal neoplasia in asymptomatic patients.
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