Predictors of Colorectal Cancer After Negative Colonoscopy: ... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: COLON/SMALL BOWEL

Predictors of Colorectal Cancer After Negative Colonoscopy: A Population-Based Study

Singh, Harminder MD, MPH1,2; Nugent, Zoann PhD2,3; Mahmud, Salaheddin M MD, PhD2,3; Demers, Alain A PhD2,3; Bernstein, Charles N MD1

1Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

2Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

3Department of Epidemiology and Cancer Registry, CancerCare Manitoba Winnipeg, Manitoba, Canada

Correspondence: Harminder Singh, MD, MPH, Section of Gastroenterology, University of Manitoba, 805-715 McDermot Avenue, Winnipeg, Manitoba, Canada R3E3P4. E-mail: [email protected]

If you wish to receive credit for this activity, please refer to the Web site:http://www.acg.gi.org/acgjournalcme/.

Article Title: Predictors of Colorectal Cancer after Negative Colonoscopy: A Population-Based Study

published online 10 November 2009

Received 29 January 2009; accepted 2 October 2009

Buy
CME Test

Abstract

OBJECTIVES:

A higher proportion of colorectal neoplasia among women occurs in the proximal colon, which might be more frequently missed by colonoscopy. There are no data on predictors of developing colorectal cancer (CRC) after a negative colonoscopy in usual clinical practice. We evaluated gender differences and predictors of CRC occurring after a negative colonoscopy.

METHODS:

All individuals 40 years or older with negative colonoscopy were identified from Manitoba's provincial physicians' billing claims database. Individuals with less than 5 years of coverage by the provincial health plan, earlier CRC, inflammatory bowel disease, resective colorectal surgery, or lower gastrointestinal endoscopy were excluded. CRC risk after negative colonoscopy was compared to that in the general population by standardized incidence ratios. Cox regression analysis was performed to determine the independent predictors of CRC occurring after negative colonoscopy.

RESULTS:

A total of 45,985 individuals (18,606 men; 27,379 women) were followed up for 229,090 person-years. After a negative colonoscopy, men had a 40–50% lower risk of CRC diagnosis through most of the follow-up time. Risk among women was similar to that of women in the general population in the first 3 years and then was 40–50% lower. Older subject age and performance of index colonoscopy by non-gastroenterologists were independent predictors for early/missed CRC (cancers occurring within 3 years of negative colonoscopy).

CONCLUSIONS:

Women may have a higher rate of missed/early CRCs after negative colonoscopy. Predictors of missed/early CRCs after negative colonoscopy include older age and performance of index colonoscopy by a non-gastroenterologist.