Receipt of colonoscopy following diagnosis of advanced adenomas: An analysis within integrated healthcare delivery systems Journal Article


Authors: Chubak, J.; McLerran, D.; Zheng, Y.; Singal, A. G.; Corley, D. A.; Doria-Rose, V. P.; Doubeni, C. A.; Kamineni, A.; Haas, J. S.; Halm, E. A.; Skinner, C. S.; Zauber, A. G.; Wernli, K. J.; Beaber, E. F.; on behalf of the PROSPR consortium
Article Title: Receipt of colonoscopy following diagnosis of advanced adenomas: An analysis within integrated healthcare delivery systems
Abstract: BACKGROUND: To reduce colorectal cancer incidence and mortality, experts recommend surveillance colonoscopy 3 years after advanced adenoma removal. Little is known about adherence to that interval. METHODS: We describe patterns of and factors associated with subsequent colonoscopy among persons with ≥3 adenomas and/or ≥1 adenoma with villous/tubulovillous histology in four U.S. integrated healthcare delivery systems. We report Kaplan-Meier estimators of the cumulative percentage of patients undergoing colonoscopy 6 months to 3.5 years after an index colonoscopy with high-risk findings. Combining data from three healthcare systems, we used multivariable logistic regression with inverse probability of censoring weights to estimate ORs and 95% confidence intervals (CI) for associations between patient characteristics and receipt of subsequent colonoscopy. RESULTS: Among 6,909 persons with advanced adenomas, the percent receiving a subsequent colonoscopy 6 months to 3.5 years later ranged from 18.3% (95% CI: 11.7%-27.8%) to 59.5% (95% CI: 53.8%-65.2%) across healthcare systems. Differences remained significant in the multivariable model. Patients with ≥3 adenomas were more likely than those with 1 to 2 villous/tubulovillous adenomas to undergo subsequent colonoscopy. Subsequent colonoscopy was also more common for patients ages 60-74 and less common for patients ages 80 to 89 compared with those ages 50 to 54 years at their index colonoscopy. Sex, race/ethnicity, and comorbidity index score were generally not associated with subsequent colonoscopy receipt. CONCLUSIONS: Colonoscopy within the recommended interval following advanced adenoma was underutilized and varied by healthcare system, age, and number of adenomas. IMPACT: Strategies to improve adherence to surveillance colonoscopy following advanced adenomas are needed. ©2018 American Association for Cancer Research.
Journal Title: Cancer Epidemiology Biomarkers and Prevention
Volume: 28
Issue: 1
ISSN: 1055-9965
Publisher: American Association for Cancer Research  
Date Published: 2019-01-01
Start Page: 91
End Page: 98
Language: English
DOI: 10.1158/1055-9965.Epi-18-0452
PUBMED: 30459208
PROVIDER: scopus
PMCID: PMC6324953
DOI/URL:
Notes: Article -- Export Date: 1 February 2019 -- Source: Scopus
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  1. Ann G Zauber
    314 Zauber