Leeds’ findings: Bowel cancer rates after colonoscopy vary by provider

University of Leeds | November 2019 | Bowel cancer rates after colonoscopy vary by provider

New research led by the University of Leeds looked at the number of patients whose colonoscopy found no evidence of bowel cancer, but who were subsequently diagnosed with the disease.

They found that overall the rate of these post-colonoscopy bowel cancers decreased in England. However, they found that the rates of these potentially missed cancers were lower for colonoscopies performed by the NHS than those performed by independent providers on behalf of the NHS.

Co-author Professor Eva Morris, from the University of Leeds’ School of Medicine and the Leeds Institute for Data Analytics, said: “Overall we found the proportion of people whose bowel cancer is being missed by a colonoscopy procedure has declined, meaning that our diagnostic services are getting more and more accurate.

“However, this study reveals wide variation in the accuracy of colonoscopy tests depending on the provider, meaning that some cancers are still being missed. This urgently needs to be addressed to ensure we are detecting cancer cases as early as possible.”

Amongst people diagnosed with bowel cancer who had a colonoscopy within the NHS Bowel Cancer Screening Programme, 3.6% could potentially have been diagnosed at an earlier time point. In contrast, if a person’s colonoscopy was undertaken by an NHS commissioned independent provider 9.3% could potentially have been diagnosed sooner.

The researchers say that if the lower rate had been achieved over the entire nine-year study period, more than 3,900 cases of colorectal cancer could have been prevented or diagnosed earlier (Source: University of Leeds).

Read the news release from the University of Leeds in full here

The study’s findings have now been published in the BMJ 

Burr, N.E., et al. | 2019| Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study| 

Abstract

Objectives To quantify post-colonoscopy colorectal cancer (PCCRC) rates in England by using recent World Endoscopy Organisation guidelines, compare incidence among colonoscopy providers, and explore associated factors that could benefit from quality improvement initiatives.

 

Design Population based cohort study.

Setting National Health Service in England between 2005 and 2013.

Population All people undergoing colonoscopy and subsequently diagnosed as having colorectal cancer up to three years after their investigation (PCCRC-3yr).

 

Main outcome measures National trends in incidence of PCCRC (within 6-36 months of colonoscopy), univariable and multivariable analyses to explore factors associated with occurrence, and funnel plots to measure variation among providers.

Results The overall unadjusted PCCRC-3yr rate was 7.4% (9317/126 152), which decreased from 9.0% in 2005 to 6.5% in 2013 (P<0.01). Rates were lower for colonoscopies performed under the NHS bowel cancer screening programme (593/16 640, 3.6%), while they were higher for those conducted by non-NHS providers (187/2009, 9.3%). Rates were higher in women, in older age groups, and in people with inflammatory bowel disease or diverticular disease, in those with higher comorbidity scores, and in people with previous cancers. Substantial variation in rates among colonoscopy providers remained after adjustment for case mix.

Conclusions Wide variation exists in PCCRC-3yr rates across NHS colonoscopy providers in England. The lowest incidence was seen in colonoscopies performed under the NHS bowel cancer screening programme. Quality improvement initiatives are needed to address this variation in rates and prevent colorectal cancer by enabling earlier diagnosis, removing premalignant polyps, and therefore improving outcomes.

The full article is available from The BMJ 

Visual abstract 

 

 

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