Variations between endoscopists in rates of detection of colorectal neoplasia and their impact on a regional screening program based on colonoscopy after fecal occult blood testing
Received 7 May 2009; accepted 28 August 2009. published online 18 November 2009.
Background
There are few data about the performance variability among endoscopists participating to nationwide or regionwide colorectal cancer screening programs.
Objective
To assess the variability of neoplasia detection rates among endoscopists participating in a regional colorectal cancer screening program based on colonoscopy after biennial fecal occult blood testing (FOBT).
Design
Two rounds of colonoscopy were performed: round 1 took place in 2003 and 2004, and round 2 took place in 2005 and 2006. Secondary analysis of colonoscopy findings from the first 2 rounds was performed by using data drawn from all endoscopists who performed more than 30 colonoscopies in each round. Detection rates were adjusted for patient age and sex, and logistic regression analyses were conducted including these 2 variables and round number (1 or 2).
Setting
District of Ille-et-Vilaine in Brittany (population >900,000) between 2003 and 2007.
Main Outcome Measurements
The per-endoscopist adjusted rates of colonoscopies with at least 1, 2, or 3 adenomas, 1 adenoma 10 mm or larger, or a cancer.
Results
Among the 18 endoscopists who performed 3462 colonoscopies, the adjusted detection rates were in the following ranges: at least 1 adenoma, 25.4% to 46.8%; 2 adenomas, 5.1% to 21.7%; 3 adenomas, 2.7% to 12.4%; 1 adenoma 10 mm or larger, 14.2% to 28.0%; and cancer, 6.3% to 16.4%. Multivariate analyses showed that the endoscopist was not an independent predictor of cancer detection, but was an independent predictor of detecting adenomas, regardless of category; the R2 of the models ranged from 6% to 13% only.
Limitations
Other factors known to influence colorectal neoplasia occurrence and withdrawal time could not be taken into account.
Conclusions
In a screening program with a high compliance rate with colonoscopy after FOBT, interendoscopist variability had no effect on cancer detection, but did influence identification of adenomas. The clinical impact of such findings merits further evaluation.
Current affiliations: Department of Gastroenterology (J.-F.B., S.M.), Centre hospitalo-universitaire, Rennes, France, Department of Epidemiology and Public Health (S.H., E.L., F.R.), Centre hospitalo-universitaire, Rennes, France, Association for Cancer Screening in Ille-et-Vilaine ADECI 35 (C.P., G.D.), Rennes, France
Reprint requests: Jean-François Bretagne, MD, Service des Maladies de l'Appareil Digestif, Hôpital Pontchaillou, 35033 Rennes Cedex, France.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
ABSTRACT