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Incident Rates of Colonic Neoplasia According to Age and Gender: Implications for Screening Colonoscopy Intervals
Abstracts
W1103 Incident Rates of Colonic Neoplasia According to Age and Gender: Implications for Screening Colonoscopy Intervals Gavin Harewood, Garrett Lawlor
W1104 Incident Rates of Colonic Neoplasia in Older Patients: When Should We Stop Screening? Gavin Harewood, Garrett Lawlor, Mark Larson
Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over 50 years regardless of age beyond 50 years or gender. However, individual patients’ risks may vary according to age and gender. This study aimed to characterize neoplasia occurrence in a large patient cohort undergoing colonoscopy. Methods: All patients undergoing 2 colonoscopies at least 12 months apart between 1996 and 2000, with normal findings on the index colonoscopy, were identified using our endoscopic database to determine the incidence of colonic neoplasia. Patients were classified according to a) age: !50, 50-64, 65-74, R75 years, and b) gender. Results: Overall, 2,041 patients underwent two colonoscopies at least 12 months apart (median interval, 154 weeks) with normal findings on initial examination. On subsequent endoscopy, polyps R5 mm were detected in 151 (7.4%) patients and polyps R10 mm in 50 (2.5%). Kaplan-Meier curve (figure) for neoplasia occurrence demonstrated similar rates for all patients R65 years (log rank test). Using a Cox proportional hazards model, hazard ratios (95% C.I.) for neoplasia (polyps R5 mm and R10 mm) demonstrated equivalent neoplasia rates among gender and age groups R65 years; however rates in females aged 50-64 were lower than age-matched males (table). Conclusions: Rates of incident neoplasia are similar among patients of different gender and age groups over 65 years on screening colonoscopy; rates in females aged 50-64 are lower than age-matched males. From a health resource utilization perspective, these findings support current recommendations for similar screening intervals for patients over 65 years regardless of age and gender. However, consideration could be given to commencing screening at age 50 in males and age 65 in females.
Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over 50 years. However, there is no consensus regarding what age is appropriate to stop screening. This study aimed to characterize neoplasia occurrence/recurrence in a large cohort of patients R70 years undergoing colonoscopy. Methods: All patients R70 years undergoing 2 colonoscopies at least 12 months apart between 1996 and 2000 were identified using our endoscopic database to determine the incidence of colonic neoplasia. Patients were classified based on a) age: 70-74, 75-79, R80 years, and b) polyp detection on initial examination, i.e. subsequent examination for screening or surveillance. Results: Overall, 1,353 patients underwent two colonoscopies at least 12 months apart (median interval, 140 weeks) with removal of polyp on initial examination in 726 (53.7%) patients (surveillance cohort). On subsequent endoscopy, polyps R10 mm were detected in 54 (4.0%) and cancer in 13 (1.0%). All age groups were well matched with respect to proportion of screening/surveillance endoscopies (p Z 0.9) and polyp size on initial colonoscopy among the surveillance group (p Z 0.9). Kaplan-Meier curve (figure) for neoplasia occurrence/recurrence demonstrated no difference in neoplasia development among age groups (log rank test). Adjusted hazard ratios for neoplasia (polyps R10 mm, cancer) using a Cox proportional hazards model, demonstrated a slight increase in development of polyps R10 mm with advancing age and a sharper increase in cancer rates (table). Conclusions: Prior history of neoplasia remains a strong risk factor for colorectal neoplasia development in elderly patients and should be considered when deciding need for continuing screening/surveillance. Incident neoplasia rates rise slowly with advancing age although cancer rates rise more sharply. Therefore, screening still retains a role in elderly patients. However, clinical judgment is required to individualize screening practice.
Hazard ratios (95% C.I.) for neoplasia occurrence:
Adjusted hazard ratios (95% C.I.) for neoplasia occurrence/recurrence:)
AB252 GASTROINTESTINAL ENDOSCOPY Volume 61, No. 5 : 2005
www.mosby.com/gie
W1103 Incident Rates of Colonic Neoplasia According to Age and Gender: Implications for Screening Colonoscopy Intervals Gavin Harewood, Garrett Lawlor
W1104 Incident Rates of Colonic Neoplasia in Older Patients: When Should We Stop Screening? Gavin Harewood, Garrett Lawlor, Mark Larson
Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over 50 years regardless of age beyond 50 years or gender. However, individual patients’ risks may vary according to age and gender. This study aimed to characterize neoplasia occurrence in a large patient cohort undergoing colonoscopy. Methods: All patients undergoing 2 colonoscopies at least 12 months apart between 1996 and 2000, with normal findings on the index colonoscopy, were identified using our endoscopic database to determine the incidence of colonic neoplasia. Patients were classified according to a) age: !50, 50-64, 65-74, R75 years, and b) gender. Results: Overall, 2,041 patients underwent two colonoscopies at least 12 months apart (median interval, 154 weeks) with normal findings on initial examination. On subsequent endoscopy, polyps R5 mm were detected in 151 (7.4%) patients and polyps R10 mm in 50 (2.5%). Kaplan-Meier curve (figure) for neoplasia occurrence demonstrated similar rates for all patients R65 years (log rank test). Using a Cox proportional hazards model, hazard ratios (95% C.I.) for neoplasia (polyps R5 mm and R10 mm) demonstrated equivalent neoplasia rates among gender and age groups R65 years; however rates in females aged 50-64 were lower than age-matched males (table). Conclusions: Rates of incident neoplasia are similar among patients of different gender and age groups over 65 years on screening colonoscopy; rates in females aged 50-64 are lower than age-matched males. From a health resource utilization perspective, these findings support current recommendations for similar screening intervals for patients over 65 years regardless of age and gender. However, consideration could be given to commencing screening at age 50 in males and age 65 in females.
Introduction: Current guidelines endorse colon cancer screening every 5-10 years in patients over 50 years. However, there is no consensus regarding what age is appropriate to stop screening. This study aimed to characterize neoplasia occurrence/recurrence in a large cohort of patients R70 years undergoing colonoscopy. Methods: All patients R70 years undergoing 2 colonoscopies at least 12 months apart between 1996 and 2000 were identified using our endoscopic database to determine the incidence of colonic neoplasia. Patients were classified based on a) age: 70-74, 75-79, R80 years, and b) polyp detection on initial examination, i.e. subsequent examination for screening or surveillance. Results: Overall, 1,353 patients underwent two colonoscopies at least 12 months apart (median interval, 140 weeks) with removal of polyp on initial examination in 726 (53.7%) patients (surveillance cohort). On subsequent endoscopy, polyps R10 mm were detected in 54 (4.0%) and cancer in 13 (1.0%). All age groups were well matched with respect to proportion of screening/surveillance endoscopies (p Z 0.9) and polyp size on initial colonoscopy among the surveillance group (p Z 0.9). Kaplan-Meier curve (figure) for neoplasia occurrence/recurrence demonstrated no difference in neoplasia development among age groups (log rank test). Adjusted hazard ratios for neoplasia (polyps R10 mm, cancer) using a Cox proportional hazards model, demonstrated a slight increase in development of polyps R10 mm with advancing age and a sharper increase in cancer rates (table). Conclusions: Prior history of neoplasia remains a strong risk factor for colorectal neoplasia development in elderly patients and should be considered when deciding need for continuing screening/surveillance. Incident neoplasia rates rise slowly with advancing age although cancer rates rise more sharply. Therefore, screening still retains a role in elderly patients. However, clinical judgment is required to individualize screening practice.
Hazard ratios (95% C.I.) for neoplasia occurrence:
Adjusted hazard ratios (95% C.I.) for neoplasia occurrence/recurrence:)
AB252 GASTROINTESTINAL ENDOSCOPY Volume 61, No. 5 : 2005
www.mosby.com/gie