Published online Sep 14, 2018. doi: 10.3748/wjg.v24.i34.3919
Peer-review started: July 3, 2018
First decision: July 18, 2018
Revised: July 25, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: September 14, 2018
To evaluate the National Cancer Institute (NCI) Colorectal Cancer (CRC) Risk Assessment Tool as a predictor for the presence of adenomatous polyps (AP) found during screening or surveillance colonoscopy.
This is a retrospective single center observational study. We collected data of adenomatous polyps in each colonoscopy and then evaluated the lifetime CRC risk. We calculated the AP prevalence across risk score quintiles, odds ratios of the prevalence of AP across risk score quintiles, area under curves (AUCs) and Youden’s indexes to assess the optimal risk score cut off value for AP prevalence status.
The prevalence of AP gradually increased throughout the five risk score quintiles: i.e., 27.63% in the first and 51.35% in the fifth quintile. The odd ratios of AP prevalence in the fifth quintile compared to the first and second quintile were 2.76 [confidence interval (CI): 1.71-4.47] and 2.09 (CI: 1.32-3.30). The AUC for all patients was 0.62 (CI: 0.58-0.66). Youden’s Index indicated the optimal risk score cutoff value discriminating AP prevalence status was 3.60.
Patients with the higher NCI risk score have higher risk of AP and subsequent CRC; therefore, measures to increase the effectiveness of CRC detection in these patients include longer withdrawal time, early surveillance colonoscopy, and choosing flexible colonoscopy over other CRC screening modalities.
Core tip: Due to health, financial and social burden of colorectal cancer (CRC), it is necessary to assess the risk of cancer development earlier. National Cancer Institute (NCI) CRC risk prediction model helps identifying people who are at increased risk of developing CRC. Our study demonstrated that NCI CRC risk prediction tool could also estimate the risk of having Adenomatous polyps (AP) in patients undergoing screening or surveillance colonoscopy. The results revealed that the odds ratios of AP prevalence increase progressively throughout the five quintiles of risk scores. Therefore, measures to increase the effectiveness of CRC screening in these patients should be implemented using longer withdrawal times, early surveillance colonoscopy, and choosing flexible colonoscopy over other CRC screening modalities.