Aims:
The English Bowel Cancer Screening Programme (BCSP) offers individuals aged 60 to 74 years guaiac FOB testing, with an invitation for colonoscopy if positive. Post-polypectomy surveillance is performed by quality-accredited colonoscopists within the BCSP for individuals within the screening age range.
Methods:
Details were extracted from the BSCP database for 41519 individuals who attended surveillance (in the intermediate or high risk category) from the start of the BCSP in 2006 until January 2017. Data were analysed using Stata 14. Multivariate logistic regression was performed for the outcome of advanced adenoma (AA) at first surveillance, defined as size ≥10 mm, ≥25% villous architecture, or high-grade dysplasia (HGD).
Considered in the analysis were person factors: gender, age, smoking status, alcohol intake, BMI, co-morbidity; and procedure factors: quality of examination, number of adenomas, size of largest adenoma, villous architecture, HGD, proximal location, piecemeal resection, and surveillance interval.
Results:
The multivariate odds ratio (OR) for baseline factors found to have statistical significance are presented below.
Male gender; OR 1.13 (p0.001.)
Suboptimal examination*; OR 1.46 (p0.000).
Total number of adenomas (multiplicity):
1 OR 1
2 OR 1.56 (p0.000)
3 OR 1.58 (p0.000)
4 OR 1.90 (p0.000)
5 OR 2.24 (p0.000)
6 – 9 OR 2.47 (p0.000)
≥10 OR 3.03 (p0.000)
Maximum villous architecture:
TA OR 1
TVA OR 1.37 (p0.000)
VA OR 1.70 (p0.000)
Non-pedunculated adenoma ≥10 mm; OR 1.38 (p0.000)
Current smoker; OR 1.16 (p0.001)
Alcohol intake ≥15 units/week; OR 1.09 (p0.010)
ASA grade#:
1 OR 1
2 OR 1.09 (p0.019)
3 – 5 OR 1.33 (p0.000)
(*Suboptimal defined as either poor bowel prep and/or incomplete to caecum.
# American Society of Anaesthesiologists grade).
Conclusions:
The only factor with an OR > 2 was adenoma multiplicity at baseline. These findings will help inform future surveillance algorithms.
