Endoscopy 2019; 51(08): 733-741
DOI: 10.1055/a-0919-4803
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Risk of post-colonoscopy colorectal cancer in Denmark: time trends and comparison with Sweden and the English National Health Service

Lasse Pedersen
1   Department of Surgical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
,
Roland Valori
2   Department of Gastroenterology, Gloucestershire Hospitals, Gloucester, United Kingdom
,
Inge Bernstein
1   Department of Surgical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
,
Karen Lindorff-Larsen
3   Nordsim: Center for Skills Training and Simulation, Aalborg University Hospital, Aalborg, Denmark
,
Charlotte Green
4   Department of Emergency, Aarhus University Hospital, Aarhus, Denmark
,
Christian Torp-Pedersen
5   Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
› Author Affiliations
Further Information

Publication History

submitted: 16 November 2018

accepted after revision: 10 April 2019

Publication Date:
07 June 2019 (online)

Abstract

Background The post-colonoscopy colorectal cancer (PCCRC) rate is a key quality indicator for colonoscopy. Previously published PCCRC rates have been difficult to compare owing to differences in methodology. The primary aim of this study was to compare Danish PCCRC rates internationally and to calculate Danish PCCRC rates using the World Endoscopy Organization (WEO) consensus method for future comparison. The secondary aim was to identify factors associated with PCCRC.

Methods National registries were used to examine the risk of PCCRC. The Danish 3-year rate of PCCRC (PCCRC-3yr) was calculated using previously published methods from England, Sweden, and the WEO. Poisson regression analysis was performed to identify factors associated with PCCRC.

Results The Danish PCCRC-3yr was significantly higher than the rate in the English NHS (relative risk [RR] 1.12, 95 % confidence interval [CI] 1.05 – 1.19) and Sweden (RR 1.15, 95 %CI 1.06 – 1.24). The Danish PCCRC-3yr based on the WEO consensus method fell from 22.5 % in 2001 to 7.9 % in 2012. The multivariable Poisson regression model found PCCRC to be significantly associated with diverticulitis (RR 3.25, 95 %CI 2.88 – 3.66), ulcerative colitis (RR 3.44, 95 %CI 2.79 – 4.23), hereditary cancer (age < 60 years: RR 7.39, 95 %CI 5.77 – 9.47; age ≥ 60 years: RR 3.81, 95 %CI 2.74 – 5.31), and location in the transverse (RR 1.57, 95 %CI 1.28 – 1.94) and ascending colon (RR 1.85, 95 %CI 1.64 – 2.08).

Conclusions The PCCRC-3yr was higher in Denmark than in comparable countries. Differences in colonoscopist training, background, and certification are possible contributing factors. A review of colonoscopist training and certification in Denmark, and continuous audit and feedback of colonoscopist performance may reduce PCCRC-3yr.

 
  • References

  • 1 Bray F, Ferlay J, Soerjomataram I. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424
  • 2 Ingeholm P. Danish Colorectal Cancer Group database annual report 2016. Available from: https://dccg.dk/wp-content/uploads/2017/10/Aarsrapport_2016.pdf Accessed: 17 September 2018
  • 3 Rabeneck L, Paszat L. Circumstances in which colonoscopy misses cancer. Frontline Gastroenterol 2010; 3: 52-58
  • 4 Morris EJA, Rutter MD, Finan PJ. et al. Post-colonoscopy colorectal cancer (PCCRC) rates vary considerably depending on the method used to calculate them: a retrospective observational population-based study of PCCRC in the English National Health Service. Gut 2015; 64: 1248-1256
  • 5 Rutter MD, Beintaris I, Valori R. et al. World Endoscopy Organization consensus statements on post-colonoscopy and post-imaging colorectal cancer. Gastroenterology 2018; 155: 909-925
  • 6 Bressler B, Paszat LF, Chen Z. et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007; 132: 96-102
  • 7 Cooper GS, Xu F, Barnholtz Sloan JS. et al. Prevalence and predictors of interval colorectal cancers in medicare beneficiaries. Cancer 2012; 118: 3044-3052
  • 8 le Clercq CMC, Bouwens MWE, Rondagh EJA. et al. Postcolonoscopy colorectal cancers are preventable: a population-based study. Gut 2014; 63: 957-963
  • 9 Singh H, Nugent Z, Demers AA. et al. Rate and predictors of early/missed colorectal cancers after colonoscopy in Manitoba: a population-based study. Am J Gastroenterol 2010; 105: 2588-2596
  • 10 Gjerstorff ML. The Danish Cancer Registry. Scand J Public Health 2011; 39: 42-45
  • 11 Schmidt M, Schmidt SAJ, Sandegaard JL. et al. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7: 449-490
  • 12 Charlson ME, Pompei P, Ales KL. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383
  • 13 Kildemoes HW, Sørensen HT, Hallas J. The Danish National Prescription Registry. Scand J Public Health 2011; 39 (Suppl. 07) 38-41
  • 14 Quan H, Sundararajan V, Halfon P. et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43: 1132-1139
  • 15 Forsberg A, Hammar U, Ekbom A. et al. Post-colonoscopy colorectal cancers in Sweden. Eur J Gastroenterol Hepatol 2017; 29: 855-860
  • 16 Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991
  • 17 Arain MA, Sawhney M, Sheikh S. et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol 2010; 105: 1189-1195
  • 18 Yang JF, Tang SJ, Lash RH. et al. Anatomic distribution of sessile serrated adenoma/polyp with and without cytologic dysplasia. Arch Pathol Lab Med 2015; 139: 388-393
  • 19 Cooper GS, Xu F, Schluchter MD. et al. Diverticulosis and the risk of interval colorectal cancer. Dig Dis Sci 2014; 59: 2765-2772
  • 20 Lam TJ, Meurs-Szojda MM, Gundlach L. et al. There is no increased risk for colorectal cancer and adenomas in patients with diverticulitis: a retrospective longitudinal study. Colorectal Dis 2010; 12: 1122-1126
  • 21 Meurs-Szojda MM, Droste JSTS, Kuik DJ. et al. Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4,241 colonoscopies. Int J Colorectal Dis 2008; 23: 979-984
  • 22 Morini S, Zullo A, Hassan C. et al. Diverticulosis and colorectal cancer: between lights and shadows. J Clin Gastroenterol 2008; 42: 763-770
  • 23 Brenner H, Chang-Claude J, Seiler CM. et al. Interval cancers after negative colonoscopy: population-based case-control study. Gut 2012; 61: 1576-1582
  • 24 Gryfe R. Inherited colorectal cancer syndromes. Clin Colon Rectal Surg 2009; 22: 198-208
  • 25 Yaeger R, Shah MA, Miller VA. et al. Genomic alterations observed in colitis-associated cancers are distinct from those found in sporadic colorectal cancers and vary by type of inflammatory bowel disease. Gastroenterology 2016; 151: 278-287
  • 26 Bowles CJA, Leicester R, Romaya C. et al. A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?. Gut 2004; 53: 277-283
  • 27 Quyn AJ, Fraser CG, Stanners G. et al. Scottish Bowel Screening Programme colonoscopy quality – scope for improvement. Colorectal Dis 2018; 20: 277-283
  • 28 Valori RM, Thomas-Gibson S. Commentary: Accrediting colonoscopy services and colonoscopists for screening makes a difference. Colorectal Dis 2018; 20: 283-285
  • 29 Baxter NN, Sutradhar R, Forbes SS. et al. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology 2011; 140: 65-72
  • 30 Rabeneck L, Paszat LF, Saskin R. Endoscopist specialty is associated with incident colorectal cancer after a negative colonoscopy. Clin Gastroenterol Hepatol 2010; 8: 275-279
  • 31 Gotfried J, Bernstein M, Ehrlich AC. et al. Administrative database research overestimates the rate of interval colon cancer. J Clin Gastroenterol 2015; 49: 483-490
  • 32 Erichsen R, Baron JA, Stoffel EM. et al. Characteristics and survival of interval and sporadic colorectal cancer patients: a nationwide population-based cohort study. Am J Gastroenterol 2013; 108: 1332-1340
  • 33 Rasmussen M, Tybjerg J, Njor S. Danish bowel cancer screening database annual report 2016. 10/2017: 1-99 Available from: https://www.sundhed.dk/content/cms/45/61245_dts%C3%A5rsrapport-2016_offentlig-version.pdf Accessed: May 2019
  • 34 Robertson DJ, Lieberman DA, Winawer SJ. et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut 2014; 63: 949-956