Su1227 Prevalence of Colorectal Neoplasia in Asymptomatic Average-Risk Individuals Aged 40-49 Years Undergoing Screening Colonoscopy

ObjectiveKnowing risk for advanced colorectal neoplasia (AN) could help patients and providers choose among screening tests, improving screening efficiency and uptake. We created a risk prediction model for AN to help decide which test might be preferred, a use not considered for existing models.DesignAverage-risk 50-to-80-year olds undergoing first-time screening colonoscopy were recruited from endoscopy units in Indiana. We measured sociodemographic and physical features, medical and family history and lifestyle factors and linked these to the most advanced finding. We derived a risk equation on two-thirds of the sample and assigned points to each variable to create a risk score. Scores with comparable risks were collapsed into risk categories. The model and score were tested on the remaining sample.ResultsAmong 3025 subjects in the derivation set (mean age 57.3 (6.5) years; 52% women), AN prevalence was 9.4%. The 13-variable model (c-statistic=0.77) produced three risk groups with AN risks of 1.5% (95% CI 0.72% to 2.74%), 7.06% (CI 5.89% to 8.38%) and 27.26% (CI 23.47% to 31.30%) in low-risk, intermediate-risk and high-risk groups (p value <0.001), containing 23%, 59% and 18% of subjects, respectively. In the validation set of 1475 subjects (AN prevalence of 8.4%), model performance was comparable (c-statistic=0.78), with AN risks of 2.73% (CI 1.25% to 5.11%), 5.57% (CI 4.12% to 7.34%) and 25.79% (CI 20.51% to 31.66%) in low-risk, intermediate-risk and high-risk subgroups, respectively (p<0.001), containing proportions of 23%, 59% and 18%.ConclusionAmong average-risk persons, this model estimates AN risk with high discrimination, identifying a lower risk subgroup that may be screened non-invasively and a higher risk subgroup for which colonoscopy may be preferred. The model could help guide patient–provider discussions of screening options, may increase screening adherence and conserve colonoscopy resources.

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Prevalence of advanced colorectal neoplasia according to risk categories at screening colonoscopy in a tertiary referral center.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.578 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 578-578

Author(s):

Eduardo Negrete Carballo ◽

Fidel David Huitzil Melendez

Keyword(s):

Colorectal Cancer ◽

High Risk ◽

Risk Stratification ◽

Colorectal Neoplasia ◽

Screening Colonoscopy ◽

Average Risk ◽

Moderate Risk ◽

Advanced Colorectal Neoplasia ◽

Advanced Neoplasm ◽

Colorectal Screening

578 Background: Colorectal cancer (CRC) is the third most common cancer in the world. There is strong evidence that screening for colorectal cancer improves survival in conutries with high incidence. Although Mexico is considered a country with a low incidence of CRC, 4694 potentially preventable deaths occur every year. There is no established CRC screening program in our country, risk stratification of the target populations to be screened may bring potential advantages, making the strategy more cost-effective. The Asia-Pacific Colorectal Screening (APCS) score, is a validated risk-stratification tool that helps identify individuals at risk for advanced colorectal neoplasm amongst the asymptomatic population. Methods: We performed a retrospective, cross-sectional analysis of database records from 1172 patients who underwent screening colonoscopy betwen january 2013 and november 2014. Results: The prevalence of advanced colorectal neoplasia was 2.9%. Applying the APCS stratification, 91 subjects (7.8%) were in the average risk tier, 849 subjects (72.4%) in the moderate risk tier and 232 (19.8%) subjects in the high risk tier. The prevalence of advanced neoplasia in the average risk, moderate risk and high risk groups was 0%, 2.6% and 5.1%, respectively. The subjects in the high risk tier had 2.21-fold (p = 0.021) increased prevalence of advanced neoplasia than those in the average-moderate tier. Conclusions: The APCS score is a simple risk stratification index for colorectal advanced neoplasm that uses elementary clinical information on age, gender, family history and smoking to stratify the risk of colorectal advanced neoplasm in asymptomatic subjects for priority of colorectal screening.

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Prospective assessment of the risk for colorectal neoplasia in a Mexican population according to risk categories.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15158 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15158-e15158

Author(s):

Vanessa Rosas Camargo ◽

Edgar Omar Martos Armendariz ◽

Mauricio Rivera Aguilar ◽

Jorge Humberto Hernandez-Felix ◽

Monica Lily Cordon ◽

...

Keyword(s):

Family History ◽

High Risk ◽

Screening Program ◽

Smoking Status ◽

Colorectal Neoplasia ◽

Asia Pacific ◽

Screening Colonoscopy ◽

Average Risk ◽

Prospective Assessment ◽

History Of

e15158 Background: General population screening can reduce colorectal cancer (CRC) mortality. International guidelines recommend CRC screening for asymptomatic people over 50 years. There is no established national screening program in Mexico. Even in countries with low incidence of CRC such as Mexico, targeted screening of subjects at high risk could decrease resource utilization and cost. Our aim was to describe the distribution among an average-risk population based on risk for colorectal neoplasia (CRN). Methods: We performed a prospective assessment of the risk for CRN among asymptomatic people over 50 years at Instituto Nacional de Ciencias Médicas y Nutrición between 2017-2018. The inclusion was competitive consistent with our age-sex pyramid. We included workers, non-family attendants and patients (internal medicine consultation). Each subject answered a standardized questionnaire, which included information on their age, gender, family history of CRC, diabetes, body mass index (BMI), smoking status and drinking habits. In order to stratify the population according to their risk for CRN, we used the Asia-Pacific Colorectal Screening (APCS) score. Results: We included 256 subjects. Median age was 59 y/o (50-93), 52% were female. 5% had a first-degree relative with CRC. 44% were current or ex-smoker and 9% reported alcohol consumption. 21% had diabetes. The median BMI was 27.3 (17-51). According to the APCS score, 60% were assigned as average risk (AR) and 40% as high risk (HR) for CRN. We observed a higher proportion of HR compared to our previous retrospective data (Table). Conclusions: We prospectively confirmed that using basic clinical information (age, gender, smoking status, family history of CRC, BMI and diabetes), it is possible to identify a subset of asymptomatic subjects at high risk for CRN in whom screening strategies should be prioritized. In developing countries with limited resources, a focus on high risk groups could improve cost effectiveness of screening colonoscopy. Risk stratification based on APCS score. [Table: see text]

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Exam 3: Early-Age Onset Colorectal Neoplasia in Average Risk Individuals Undergoing Screening Colonoscopy: A Systematic Review and Meta-Analysis

Gastroenterology ◽

10.1053/j.gastro.2021.08.028 ◽

2021 ◽

Keyword(s):

Systematic Review ◽

Colorectal Neoplasia ◽

Meta Analysis ◽

Screening Colonoscopy ◽

Early Age ◽

Average Risk

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Early-age onset colorectal neoplasia in average risk individuals undergoing screening colonoscopy: a systematic review and meta-analysis

Gastroenterology ◽

10.1053/j.gastro.2021.06.006 ◽

2021 ◽

Author(s):

Jennifer M. Kolb ◽

Junxiao Hu ◽

Kristen DeSanto ◽

Dexiang Gao ◽

Siddharth Singh ◽

...

Keyword(s):

Systematic Review ◽

Colorectal Neoplasia ◽

Meta Analysis ◽

Screening Colonoscopy ◽

Early Age ◽

Average Risk

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493 The Prevalence of Advanced Colorectal Neoplasia (ACN) is Lower Among Average-Risk Blacks Than Whites Undergoing Screening Colonoscopy in a Safety Net Health Care System

Gastroenterology ◽

10.1016/s0016-5085(12)60398-9 ◽

2012 ◽

Vol 142 (5) ◽

pp. S-106

Author(s):

Paul C. Schroy ◽

Alison Coe ◽

Clara A. Chen ◽

Timothy Heeren

Keyword(s):

Health Care ◽

Health Care System ◽

Colorectal Neoplasia ◽

Safety Net ◽

Screening Colonoscopy ◽

Average Risk ◽

Advanced Colorectal Neoplasia ◽

Care System

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Risk of Advanced Neoplasia Using the National Cancer Institute’s Colorectal Cancer Risk Assessment Tool

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djw181 ◽

2016 ◽

Vol 109 (1) ◽

Cited By ~ 10

Author(s):

Thomas F Imperiale ◽

Menggang Yu ◽

Patrick O Monahan ◽

Timothy E Stump ◽

Rebeka Tabbey ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Assessment ◽

Assessment Tool ◽

Colorectal Neoplasia ◽

Risk Assessment Tool ◽

Screening Colonoscopy ◽

Average Risk ◽

Tubular Adenoma ◽

Advanced Neoplasia ◽

Current Risk

Background: There is no validated, discriminating, and easy-to-apply tool for estimating risk of colorectal neoplasia. We studied whether the National Cancer Institute’s (NCI’s) Colorectal Cancer (CRC) Risk Assessment Tool, which estimates future CRC risk, could estimate current risk for advanced colorectal neoplasia among average-risk persons. Methods: This cross-sectional study involved individuals age 50 to 80 years undergoing first-time screening colonoscopy. We measured medical and family history, lifestyle information, and physical measures and calculated each person’s future CRC risk using the NCI tool’s logistic regression equation. We related quintiles of future CRC risk to the current risk of advanced neoplasia (sessile serrated polyp or tubular adenoma ≥ 1 cm, a polyp with villous histology or high-grade dysplasia, or CRC). All statistical tests were two-sided. Results: For 4457 (98.5%) with complete data (mean age = 57.2 years, SD = 6.6 years, 51.7% women), advanced neoplasia prevalence was 8.26%. Based on quintiles of five-year estimated absolute CRC risk, current risks of advanced neoplasia were 2.1% (95% confidence interval [CI] = 1.3% to 3.3%), 4.8% (95% CI = 3.5% to 6.4%), 6.4% (95% CI = 4.9% to 8.2%), 10.0% (95% CI = 8.1% to 12.1%), and 17.6% (95% CI = 15.5% to 20.6%; P < .001). For quintiles of estimated 10-year CRC risk, corresponding current risks for advanced neoplasia were 2.2% (95% CI = 1.4% to 3.5%), 4.8% (95% CI = 3.5% to 6.4%), 6.5% (95% CI = 5.0% to 8.3%), 9.3% (95% CI = 7.5% to 11.4%), and 18.4% (95% CI = 15.9% to 21.1%; P < .001). Among persons with an estimated five-year CRC risk above the median, current risk for advanced neoplasia was 12.8%, compared with 3.7% among those below the median (relative risk = 3.4, 95 CI = 2.7 to 4.4). Conclusions: The NCI’s Risk Assessment Tool, which estimates future CRC risk, may be used to estimate current risk for advanced neoplasia, making it potentially useful for tailoring and improving CRC screening efficiency among average-risk persons.

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