Minneapolis VA Health Care System Minneapolis, MN, United States
Award: Presidential Poster Award
Mohammad Bilal, MD1, Jennifer Holub, MPH2, Douglas K. Rex, MD3, David Greenwald, MD4, Aasma Shaukat, MD1 1Minneapolis VA Health Care System, Minneapolis, MN; 2GI Quality Improvement Consortium, Bethesda, MD; 3Indiana University School of Medicine, Indianapolis, IN; 4Mount Sinai Hospital, New York, NY
Introduction: Current benchmarks for adenoma detection rate (ADR) for screening colonoscopy in men and women 50 years and older are 30% and 20%, for an overall ADR benchmark of 25%. Recent guidelines have recommended lowering the age to initiate colorectal cancer (CRC) screening to 45 years. The impact of this recommendation on endoscopist ADR is not clear. Our aim was to calculate the ADR in 45-49 year old men and women undergoing screening colonoscopy compared to 50-75 year old men and women using the GIQuIC registry.
Methods: We included screening colonoscopies performed by 1126 endoscopists across the U.S. between 2014 and 2019 from GIQuIC registry. ADR was calculated for each endoscopist who performed 30 or more screening colonoscopies during the study period. We used one way ANOVA test to determine differences between ADRs among 45-49, 50-54 and 50-75 year-olds.
Results: We included 3,040,724 screening colonoscopies in 45-75 year old individuals, of which 188,801 (6.2%) were in patients 45-49, 725,919 (23.8%) in 50-54 and 2,851,923 were in 50-75 year olds. The mean ADR in the 45-49 group was 28.86% compared to 32.26% for 50-54 (p< 0.0001) and 36.80% for 50-75 (p< 0.0001). ADRs for men and women 45-49 years of age were 33.26% and 23.38%, respectively, compared to ADRs for men and women 50-54 years of age of 39.09% and 26.59% respectively (p< 0.0001 for men, p< 0.0001 for women) and 43.87 for men and 31.13 for women 50-75 respectively (p< 0.0001 and p< 0.0001). (Table 1) If the proportion of 45-49 year old screening colonoscopies increases to 25% or 50%, the overall ADR is expected to decrease to 34.4% and 31.8%.
Discussion: We found small differences in the overall ADR for 45-49-year-olds compared to 50-54-year-olds undergoing screening colonoscopy, but a meaningful difference compared to the entire screening population of 50-75 year olds. Similar trends were seen by patient gender. In our study, 45-49 year olds comprised 6.2% of the screening population. Our results suggest that practices may see a drop in their ADRs based on the proportion of individuals 45-49 years old that comprise the screening population for the practice. If the volume of screening colonoscopies in younger individuals as a proportion of all screening colonoscopies is 25% and 50%, practices may see a drop in their ADR by 2% to 5%.
Figure: Table 1. Comparison of ADR, by age group
Mohammad Bilal indicated no relevant financial relationships.
Jennifer Holub indicated no relevant financial relationships.
Douglas Rex indicated no relevant financial relationships.
David Greenwald indicated no relevant financial relationships.
Aasma Shaukat indicated no relevant financial relationships.
Mohammad Bilal, MD1, Jennifer Holub, MPH2, Douglas K. Rex, MD3, David Greenwald, MD4, Aasma Shaukat, MD1. P1196 - Impact of Addition of 45-49-Year-Olds to Screening Colonoscopy on Overall Adenoma Detection Rates Using the GIQuIC Registry, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.