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Assessing individual risk for high‐risk colorectal adenoma at first‐time screening colonoscopy
Author(s) -
Cao Yin,
Rosner Bernard A.,
Ma Jing,
Tamimi Rulla M.,
Chan Andrew T.,
Fuchs Charles S.,
Wu Kana,
Giovannucci Edward L.
Publication year - 2015
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.29533
Subject(s) - colonoscopy , adenoma , medicine , colorectal adenoma , colorectal cancer , risk assessment , general surgery , oncology , computer science , cancer , computer security
Assessing risk of colorectal adenoma at first‐time colonoscopy that are of higher likelihood of developing advanced neoplasia during surveillance could help tailor first‐line colorectal cancer screening. We developed prediction models for high‐risk colorectal adenoma (at least one adenoma ≥1 cm, or with advanced histology, or ≥3 adenomas) among 4,881 asymptomatic white men and 17,970 women who underwent colonoscopy as their first‐time screening for colorectal cancer in two prospective US studies using logistic regressions. C‐statistics and Hosmer–Lemeshow tests were used to evaluate discrimination and calibration. Ten‐fold cross‐validation was used for internal validation. A total of 330 (6.7%) men and 678 (3.8%) women were diagnosed with high‐risk adenoma at first‐time screening colonoscopy. The model for men included age, family history of colorectal cancer, BMI, smoking, sitting watching TV/VCR, regular aspirin/NSAID use, physical activity, and a joint term of multivitamin and alcohol. For women, the model included age, family history of colorectal cancer, BMI, smoking, alcohol, beef/pork/lamb as main dish, regular aspirin/NSAID, calcium, and oral contraceptive use. The C‐statistic of the model for men was 0.67 and 0.60 for women (0.64 and 0.57 in cross‐validation). Both models calibrated well. The predicted risk of high‐risk adenoma for men in the top decile was 15.4% vs . 1.8% for men in the bottom decile (Odds Ratio [OR] = 9.41), and 6.6% vs . 2.1% for women (OR = 3.48). In summary, we developed and internally validated an absolute risk assessment tool for high‐risk colorectal adenoma among the US population that may provide guidance for first‐time colorectal cancer screening.