Polish Study Calls for Using Adenoma Detection Rate to Stratify Screening and Surveillance Recommendations
Douglas K. Rex, MD, MASGE, reviewing Wieszczy P, et al. Gastroenterology 2020 Oct 13.
In this study, the risk of interval cancer was compared between doctors with high (≥20%) versus low (<20%) adenoma detection rates (ADRs) in the Polish colorectal cancer screening program between 2000 and 2011, with follow-up until 2017. The results were validated in an Austrian screening colonoscopy cohort.
In total, 39% of Polish colonoscopists had ADRs ≥20%. Among individuals with low-risk adenomas, cancer risk after colonoscopy was 0.55% among patients of low performers versus 0.22% with high performers. Among high-risk adenoma patients, the interval cancer risk was 1.14% among patients of low performers versus 0.43% among patients of high performers. After negative colonoscopy, the corresponding rates of interval cancer were 0.30% and 0.15%.
The authors suggested that because ADR is an independent predictor of the risk of interval cancer, it should be used to stratify screening and surveillance intervals.
COMMENTThis result has now been demonstrated multiple times, and the predictive value of the doctors’ ADR for interval cancer has also been previously demonstrated. Certainly, from a medical standpoint, it makes sense to include ADR in the stratification scheme for surveillance intervals.
The problem with the proposal, and the reason it’s seemingly unworkable, is that it will essentially reward low-performing colonoscopists, who will ultimately get paid more in many countries, including the U.S., for removing fewer polyps and performing more colonoscopies. We need to financially incentivize high ADR, which is fair and will help drive the quality movement forward and the occurrence of colorectal cancer down.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Wieszczy P, Waldmann E, Løberg M, et al. Colonoscopist performance and colorectal cancer risk after adenoma removal to stratify surveillance: two nationwide observational studies. Gastroenterology 2020 Oct 13. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2020.10.009)
