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Risk of advanced colorectal neoplasia according to age and gender.

Kolligs FT, Crispin A, Munte A, Wagner A, Mansmann U, Göke B - PLoS ONE (2011)

Bottom Line: Advanced neoplasia was found in 16,740 women (4.6%) and 22,684 men (8.6%).Male sex was associated with an overall increased risk of advanced neoplasia (odds ratio 1.95; 95% confidence interval, CI, 1.91 to 2.00).This suggests that starting screening earlier in life in men than in women might result in a relevant increase in the detection of asymptomatic preneoplastic and neoplastic colonic lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine II, University of Munich, Munich, Germany. fkolligs@med.uni-muenchen.de

ABSTRACT

Background: Colorectal cancer (CRC) is one of the leading causes of cancer related morbidity and death. Despite the fact that the mean age at diagnosis of CRC is lower in men, screening by colonoscopy or fecal occult blood test (FOBT) is initiated at same age in both genders. The prevalence of the common CRC precursor lesion, advanced adenoma, is well documented only in the screening population. The purpose of this study was to assess the risk of advanced adenoma at ages below screening age.

Methods and findings: We analyzed data from a census of 625,918 outpatient colonoscopies performed in adults in Bavaria between 2006 and 2008. A logistic regression model to determine gender- and age-specific risk of advanced neoplasia was developed. Advanced neoplasia was found in 16,740 women (4.6%) and 22,684 men (8.6%). Male sex was associated with an overall increased risk of advanced neoplasia (odds ratio 1.95; 95% confidence interval, CI, 1.91 to 2.00). At any age and in any indication group, more colonoscopies were needed in women than in men to detect advanced adenoma or cancer. At age 75 14.8 (95% CI, 14.4-15.2) screening, 18.2 (95% CI, 17.7-18.7) diagnostic, and 7.9 (95% CI, 7.6-8.2) colonoscopies to follow up on a positive FOBT (FOBT colonoscopies) were needed to find advanced adenoma in women. At age 50 39.0 (95% CI, 38.0-40.0) diagnostic, and 16.3 (95% CI, 15.7-16.9) FOBT colonoscopies were needed. Comparable numbers were reached 20 and 10 years earlier in men than in women, respectively.

Conclusions: At any age and independent of the indication for colonoscopy, men are at higher risk of having advanced neoplasia diagnosed upon colonoscopy than women. This suggests that starting screening earlier in life in men than in women might result in a relevant increase in the detection of asymptomatic preneoplastic and neoplastic colonic lesions.

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Related in: MedlinePlus

Predicted probabilities of advanced adenoma (A), cancer (B), and advanced neoplasia (C) in screening and diagnostic groups according to age and gender.The bands mark the corresponding 95% confidence intervals.
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pone-0020076-g001: Predicted probabilities of advanced adenoma (A), cancer (B), and advanced neoplasia (C) in screening and diagnostic groups according to age and gender.The bands mark the corresponding 95% confidence intervals.

Mentions: Data were described using appropriate measures of location and dispersion. Statistical inferences on the risks of advanced adenoma, cancer, and advanced neoplasia were based on logistic regression models including a fixed set of independent variables: Gender, age, age squared, age cubed (to account for the obvious nonlinear relations), indication, completeness of the examination, and intravenous sedation. Intravenous sedation was included because sedation has previously been shown to be associated with completeness of colonoscopy [24]. More detailed information is provided with the supplementary methods S1. While the presentation of the number of colonoscopies needed to identify cancer or advanced adenoma and figure 1 were restricted to the relevant age group of potential screening clients (40 to 79 years of age), all patients were included in the analyses. We did not use a data-driven variable selection algorithm. Model fit was assessed graphically by plotting the observed frequencies and the probabilities predicted from the regression equations. Following Regula and co-workers [16], the number of colonoscopies needed to detect one lesion was defined as the reciprocal of the probability predicted by the logistic regression model. Analogously, 95% confidence limits were calculated as reciprocals of the 95% confidence limits for the predicted probabilities. All analyses were performed using SAS version 9.2 for Linux (SAS Institute Inc., Cary, NC, USA).


Risk of advanced colorectal neoplasia according to age and gender.

Kolligs FT, Crispin A, Munte A, Wagner A, Mansmann U, Göke B - PLoS ONE (2011)

Predicted probabilities of advanced adenoma (A), cancer (B), and advanced neoplasia (C) in screening and diagnostic groups according to age and gender.The bands mark the corresponding 95% confidence intervals.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3101231&req=5

pone-0020076-g001: Predicted probabilities of advanced adenoma (A), cancer (B), and advanced neoplasia (C) in screening and diagnostic groups according to age and gender.The bands mark the corresponding 95% confidence intervals.
Mentions: Data were described using appropriate measures of location and dispersion. Statistical inferences on the risks of advanced adenoma, cancer, and advanced neoplasia were based on logistic regression models including a fixed set of independent variables: Gender, age, age squared, age cubed (to account for the obvious nonlinear relations), indication, completeness of the examination, and intravenous sedation. Intravenous sedation was included because sedation has previously been shown to be associated with completeness of colonoscopy [24]. More detailed information is provided with the supplementary methods S1. While the presentation of the number of colonoscopies needed to identify cancer or advanced adenoma and figure 1 were restricted to the relevant age group of potential screening clients (40 to 79 years of age), all patients were included in the analyses. We did not use a data-driven variable selection algorithm. Model fit was assessed graphically by plotting the observed frequencies and the probabilities predicted from the regression equations. Following Regula and co-workers [16], the number of colonoscopies needed to detect one lesion was defined as the reciprocal of the probability predicted by the logistic regression model. Analogously, 95% confidence limits were calculated as reciprocals of the 95% confidence limits for the predicted probabilities. All analyses were performed using SAS version 9.2 for Linux (SAS Institute Inc., Cary, NC, USA).

Bottom Line: Advanced neoplasia was found in 16,740 women (4.6%) and 22,684 men (8.6%).Male sex was associated with an overall increased risk of advanced neoplasia (odds ratio 1.95; 95% confidence interval, CI, 1.91 to 2.00).This suggests that starting screening earlier in life in men than in women might result in a relevant increase in the detection of asymptomatic preneoplastic and neoplastic colonic lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine II, University of Munich, Munich, Germany. fkolligs@med.uni-muenchen.de

ABSTRACT

Background: Colorectal cancer (CRC) is one of the leading causes of cancer related morbidity and death. Despite the fact that the mean age at diagnosis of CRC is lower in men, screening by colonoscopy or fecal occult blood test (FOBT) is initiated at same age in both genders. The prevalence of the common CRC precursor lesion, advanced adenoma, is well documented only in the screening population. The purpose of this study was to assess the risk of advanced adenoma at ages below screening age.

Methods and findings: We analyzed data from a census of 625,918 outpatient colonoscopies performed in adults in Bavaria between 2006 and 2008. A logistic regression model to determine gender- and age-specific risk of advanced neoplasia was developed. Advanced neoplasia was found in 16,740 women (4.6%) and 22,684 men (8.6%). Male sex was associated with an overall increased risk of advanced neoplasia (odds ratio 1.95; 95% confidence interval, CI, 1.91 to 2.00). At any age and in any indication group, more colonoscopies were needed in women than in men to detect advanced adenoma or cancer. At age 75 14.8 (95% CI, 14.4-15.2) screening, 18.2 (95% CI, 17.7-18.7) diagnostic, and 7.9 (95% CI, 7.6-8.2) colonoscopies to follow up on a positive FOBT (FOBT colonoscopies) were needed to find advanced adenoma in women. At age 50 39.0 (95% CI, 38.0-40.0) diagnostic, and 16.3 (95% CI, 15.7-16.9) FOBT colonoscopies were needed. Comparable numbers were reached 20 and 10 years earlier in men than in women, respectively.

Conclusions: At any age and independent of the indication for colonoscopy, men are at higher risk of having advanced neoplasia diagnosed upon colonoscopy than women. This suggests that starting screening earlier in life in men than in women might result in a relevant increase in the detection of asymptomatic preneoplastic and neoplastic colonic lesions.

Show MeSH
Related in: MedlinePlus