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Quality Assurance in Colorectal Cancer Screening Program

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Colorectal Cancer Screening

Abstract

In an organized screening, quality assurance by setting targets to be met and continuous monitoring of key indicators using the relevant data collected within a program is its major difference from opportunistic screening. Those key indicators are frequently monitored and evaluated by the screening organizer to ensure that screening is well delivered and conducted. In organized colorectal cancer (CRC) screening program, screening test uptake, diagnostic examination compliance, screening test performance, and diagnostic examinations are closely associated with the effectiveness in preventing CRC and CRC death. Though CRC incidence or mortality is the most robust outcome to measure the performance of a screening program, it usually takes a long time to observe. Several quality metrics were developed, validated, and have been demonstrated to be associated with important outcomes (i.e., CRC incidence or mortality), it is of utmost importance to implement quality assurance mechanism in a program. In this chapter, those important quality indicators will be introduced and discussed.

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References

  • Aniwan S, Orkoonsawat P, Viriyautsahakul V, et al. The secondary quality Indicator to improve prediction of adenoma miss rate apart from adenoma detection rate. Am J Gastroenterol. 2016;111:723–9.

    Article  PubMed  Google Scholar 

  • ASGE Standards of Practice Committee; Saltzman JR, Cash BD, et al. Bowel preparation before colonoscopy. Gastrointest Endosc. 2015;81:781–94.

    Google Scholar 

  • Australian Institute of Health and Welfare 2014. Key performance indicators for the National Bowel Cancer Screening Program: Technical report. Cancer series no. 87. Cat. no. CAN 84. Canberra: AIHW.

    Google Scholar 

  • Baxter NN, Sutradhar R, Forbes SS, et al. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology. 2011;140:65–72.

    Article  PubMed  Google Scholar 

  • Bernstein C, Thorn M, Monsees K, et al. A prospective study of factors that determine cecal intubation time at colonoscopy. Gastrointest Endosc. 2005;61:72–5.

    Article  PubMed  Google Scholar 

  • BowelScreen. Guidelines for quality assurance in colorectal screening. Dublin: National Screening Service; 2017.

    Google Scholar 

  • Brenner H, Tao S. Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy. Eur J Cancer. 2013;49:3049–54.

    Article  CAS  PubMed  Google Scholar 

  • Bronzwaer MES, Depla A, van Lelyveld N, et al. Quality assurance of colonoscopy within the Dutch national colorectal cancer screening program. Gastrointest Endosc. 2019;89:1–13.

    Article  PubMed  Google Scholar 

  • Bucci C, Rotondano G, Hassan C, et al. Optimal bowel cleansing for colonoscopy: split the dose! A series of meta-analyses of controlled studies. Gastrointest Endosc. 2014;80:566–76. e2

    Article  PubMed  Google Scholar 

  • Cha JM, Suh M, Kwak MS, et al. Risk of interval Cancer in fecal immunochemical test screening significantly higher during the summer months: results from the National Cancer Screening Program in Korea. Am J Gastroenterol. 2018;113:611–21.

    Article  PubMed  Google Scholar 

  • Cheng SY, Li MC, Chia SL, et al. Factors affecting compliance with confirmatory colonoscopy after a positive fecal immunochemical test in a national colorectal screening program. Cancer. 2018;124:907–15.

    Article  PubMed  Google Scholar 

  • Chiang TH, Chuang SL, Chen SL, et al. Difference in performance of fecal immunochemical tests with the same hemoglobin cutoff concentration in a nationwide colorectal cancer screening program. Gastroenterology. 2014;147:1317–26.

    Article  PubMed  Google Scholar 

  • Chilton A et al. Quality assurance guidelines for colonoscopy. NHS BCSP Publ., 2011.

    Google Scholar 

  • Chiu HM, Lin JT, Wang HP, et al. The impact of colon preparation timing on colonoscopic detection of colorectal neoplasms--a prospective endoscopist-blinded randomized trial. Am J Gastroenterol. 2006;101:2719–25.

    Article  PubMed  Google Scholar 

  • Chiu HM, Chen SL, Yen AM, et al. Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the one million Taiwanese screening program. Cancer. 2015;121:3221–9.

    Article  PubMed  Google Scholar 

  • Chiu SY, Chuang SL, Chen SL, et al. Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality: analysis of the Taiwanese Nationwide colorectal Cancer screening program. Gut. 2017;66:293–300.

    Article  PubMed  Google Scholar 

  • Choi NK, Lee J, Chang Y, et al. Acute renal failure following oral sodium phosphate bowel preparation: a nationwide case-crossover study. Endoscopy. 2014;46:465–70.

    Article  PubMed  Google Scholar 

  • Chokshi RV, Hovis CE, Hollander T, et al. Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc. 2012;75:1197–203.

    Article  PubMed  Google Scholar 

  • Clark BT, Rustagi T, Laine L. What level of bowel prep quality requires early repeat colonoscopy: systematic review and meta-analysis of the impact of preparation quality on adenoma detection rate. Am J Gastroenterol. 2014;109:1714–23. 

    Google Scholar 

  • Colonoscopy quality standards and quality metrics in Taiwan. https://www.dest.org.tw/colonoscopy/content.asp?category=8&id=14

  • Cooper GS, Xu F, Barnholtz Sloan JS, et al. Prevalence and predictors of interval colorectal cancers in medicare beneficiaries. Cancer. 2012;118:3044–52.

    Article  PubMed  Google Scholar 

  • Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370:1298–306.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Corley DA, Jensen CD, Quinn VP, et al. Association between time to colonoscopy after a positive fecal test result and risk of colorectal Cancer and Cancer stage at diagnosis. JAMA. 2017;317:1631–41.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2017;49:270–97.

    Article  PubMed  Google Scholar 

  • Gavin DR, Valori RM, Anderson JT, et al. The national colonoscopy audit: a nationwide assessment of the quality and safety of colonoscopy in the UK. Gut. 2013;62:242–9.

    Article  PubMed  Google Scholar 

  • Gohel TD, Burke CA, Lankaala P, et al. Polypectomy rate: a surrogate for adenoma detection rate varies by colon segment, gender, and endoscopist. Clin Gastroenterol Hepatol. 2014;12:1137–42.

    Article  PubMed  Google Scholar 

  • Graser A, Stieber P, Nagel D, et al. Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut. 2009;58:241–8.

    Article  CAS  PubMed  Google Scholar 

  • Greenspan M, Rajan KB, Baig A, et al. Advanced adenoma detection rate is independent of nonadvanced adenoma detection rate. Am J Gastroenterol. 2013;108:1286–92.

    Article  PubMed  Google Scholar 

  • Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc. 2003;58:76–9.

    Article  PubMed  Google Scholar 

  • Hassan C, Rex DK, Zullo A, et al. Loss of efficacy and cost-effectiveness when screening colonoscopy is performed by nongastroenterologists. Cancer. 2012a;118:4404–11.

    Article  PubMed  Google Scholar 

  • Hassan C, Giorgi Rossi P, Camilloni L, et al. Meta-analysis: adherence to colorectal cancer screening and the detection rate for advanced neoplasia, according to the type of screening test. Aliment Pharmacol Ther. 2012b;36:929–40.

    Article  CAS  PubMed  Google Scholar 

  • Hassan C, East J, Radaelli F, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline – update 2019. Endoscopy. 2019;51:775–94.

    Article  PubMed  Google Scholar 

  • Hilsden RJ, Dube C, Heitman SJ, et al. The association of colonoscopy quality indicators with the detection of screen-relevant lesions, adverse events, and postcolonoscopy cancers in an asymptomatic Canadian colorectal cancer screening population. Gastrointest Endosc. 2015;82:887–94.

    Article  PubMed  Google Scholar 

  • Hilsden RJ, Bridges R, Dube C, et al. Defining benchmarks for adenoma detection rate and adenomas per colonoscopy in patients undergoing colonoscopy due to a positive fecal immunochemical test. Am J Gastroenterol. 2016;111:1743–9.

    Article  CAS  PubMed  Google Scholar 

  • Jaruvongvanich V, Sempokuya T, Laoveeravat P, et al. Risk factors associated with longer cecal intubation time: a systematic review and meta-analysis. Int J Color Dis. 2018;33:359–65.

    Article  Google Scholar 

  • Johnson DA, Barkun AN, Cohen LB, et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology. 2014;147:903–24.

    Article  PubMed  Google Scholar 

  • Jover R, Herraiz M, Alarcon O, et al. Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy. 2012;44:444–51.

    Article  CAS  PubMed  Google Scholar 

  • Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–803.

    Article  CAS  PubMed  Google Scholar 

  • Kaminski MF, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. Endoscopy. 2017a;49:378–97.

    Article  PubMed  Google Scholar 

  • Kaminski MF, Wieszczy P, Rupinski M, et al. Increased rate of adenoma detection associates with reduced risk of colorectal Cancer and death. Gastroenterology. 2017b;153:98–105.

    Article  PubMed  Google Scholar 

  • Kelly S et al. Guidelines for Quality Assurance in Colorectal Screening, Second Edition. National Screening Service, Ireland., 2017.

    Google Scholar 

  • le Clercq CM, Bouwens MW, Rondagh EJ, et al. Postcolonoscopy colorectal cancers are preventable: a population-based study. Gut. 2014;63:957–63.

    Article  PubMed  Google Scholar 

  • Lebwohl B, Kastrinos F, Glick M, et al. The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc. 2011;73:1207–14.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee JK, Liles EG, Bent S, et al. Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. Ann Intern Med. 2014;160:171.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee YC, Li-Sheng Chen S, Ming-Fang Yen A, et al. Association between colorectal Cancer mortality and gradient fecal hemoglobin concentration in colonoscopy noncompliers. J Natl Cancer Inst. 2017;109:djw269.

    Article  PubMed Central  Google Scholar 

  • Lee YC, Fann JC, Chiang TH, et al. Time to colonoscopy and risk of colorectal Cancer in patients with positive results from fecal immunochemical tests. Clin Gastroenterol Hepatol. 2019;17:1332–40. e3

    Article  PubMed  Google Scholar 

  • Lo SH, Halloran S, Snowball J, et al. Colorectal cancer screening uptake over three biennial invitation rounds in the English bowel cancer screening programme. Gut. 2015;64:282–91.

    Article  PubMed  Google Scholar 

  • Manes G, Amato A, Arena M, et al. Efficacy and acceptability of sodium picosulphate/magnesium citrate vs low-volume polyethylene glycol plus ascorbic acid for colon cleansing: a randomized controlled trial. Color Dis. 2013;15:1145–53.

    Article  CAS  Google Scholar 

  • Markowitz GS, Stokes MB, Radhakrishnan J, et al. Acute phosphate nephropathy following oral sodium phosphate bowel purgative: an underrecognized cause of chronic renal failure. J Am Soc Nephrol. 2005;16:3389–96.

    Article  CAS  PubMed  Google Scholar 

  • Martel M, Barkun AN, Menard C, et al. Split-dose preparations are superior to day-before bowel cleansing regimens: a meta-analysis. Gastroenterology. 2015;149:79–88.

    Article  PubMed  Google Scholar 

  • Meester RG, Doubeni CA, Lansdorp-Vogelaar I, et al. Variation in adenoma detection rate and the lifetime benefits and cost of colorectal Cancer screening: a microsimulation model. JAMA. 2015;313:2349–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ministry of Helath. Labour, and Welfare of Japanese government. 第1回がん検診受診率等に関するワーキンググループ. プロセス指標、特に精検受診率基準値 の見直しについて. https://www.mhlw.go.jp/file/05-Shingikai-10901000-Kenkoukyoku-Soumuka/0000127231.pdf. 2016.

  • National Institute for Public Health and the Environment (RIVM) Monitoring and Evaluation of the Colorectal Cancer Screening 2018. https://www.rivm.nl/documenten/monitoring-and-evaluation-of-colorectal-cancer-screening-programme-2018

  • Park DI, Ryu S, Kim YH, et al. Comparison of guaiac-based and quantitative immunochemical fecal occult blood testing in a population at average risk undergoing colorectal cancer screening. Am J Gastroenterol. 2010;105:2017–25.

    Article  PubMed  Google Scholar 

  • Park MJ, Choi KS, Lee YK, et al. A comparison of qualitative and quantitative fecal immunochemical tests in the Korean national colorectal cancer screening program. Scand J Gastroenterol. 2012;47:461–6.

    Article  PubMed  Google Scholar 

  • Park SK, Kim HY, Lee CK, et al. Comparison of adenoma detection rate and adenoma per colonoscopy as a quality indicator of colonoscopy. Scand J Gastroenterol. 2016;51:886–90.

    Article  PubMed  Google Scholar 

  • Parmar R, Martel M, Rostom A, et al. Validated scales for Colon cleansing: a systematic review. Am J Gastroenterol. 2016;111:197–204. quiz 205

    Article  PubMed  Google Scholar 

  • Parra-Blanco A, Kaminaga N, Kojima T, et al. Colonoscopic polypectomy with cutting current: is it safe? Gastrointest Endosc. 2000;51:676–81.

    Article  CAS  PubMed  Google Scholar 

  • Rabeneck L, Paszat LF, Saskin R, et al. Association between colonoscopy rates and colorectal cancer mortality. Am J Gastroenterol. 2010;105:1627–32.

    Article  PubMed  Google Scholar 

  • Radaelli F, Paggi S, Hassan C, et al. Split-dose preparation for colonoscopy increases adenoma detection rate: a randomised controlled trial in an organised screening programme. Gut. 2017;66:270–7.

    Article  CAS  PubMed  Google Scholar 

  • Rees CJ, Thomas Gibson S, Rutter MD, et al. UK key performance indicators and quality assurance standards for colonoscopy. Gut. 2016;65:1923–9.

    Article  PubMed  Google Scholar 

  • Regev A, Fraser G, Delpre G, et al. Comparison of two bowel preparations for colonoscopy: sodium picosulphate with magnesium citrate versus sulphate-free polyethylene glycol lavage solution. Am J Gastroenterol. 1998;93:1478–82.

    Article  CAS  PubMed  Google Scholar 

  • Reumkens A, Rondagh EJ, Bakker CM, et al. Post-colonoscopy complications: a systematic review, time trends, and meta-analysis of population-based studies. Am J Gastroenterol. 2016;111:1092–101.

    Article  PubMed  Google Scholar 

  • Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81:31–53.

    Article  PubMed  Google Scholar 

  • Rim JH, Youk T, Kang JG, et al. Fecal occult blood test results of the National Colorectal Cancer Screening Program in South Korea (2006–2013). Sci Rep. 2017;7:2804.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Robertson DJ, Lieberman DA, Winawer SJ, et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut. 2014;63:949–56.

    Article  PubMed  Google Scholar 

  • Robertson DJ, Lee JK, Boland CR, et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US multi-society task force on colorectal Cancer. Gastroenterology. 2017;152:1217–37. e3

    Article  PubMed  Google Scholar 

  • Rosen L, Bub DS, Reed JF 3rd, et al. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum. 1993;36:1126–31.

    Article  CAS  PubMed  Google Scholar 

  • Ross WA, Thirumurthi S, Lynch PM, et al. Detection rates of premalignant polyps during screening colonoscopy: time to revise quality standards? Gastrointest Endosc. 2015;81:567–74.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rutter MD, Beintaris I, Valori R, et al. World endoscopy organization consensus statements on post-colonoscopy and post-imaging colorectal Cancer. Gastroenterology. 2018;155:909–25. e3

    Article  PubMed  Google Scholar 

  • Sanduleanu S, le Clercq CM, Dekker E, et al. Definition and taxonomy of interval colorectal cancers: a proposal for standardising nomenclature. Gut. 2015;64:1257–67.

    Article  CAS  PubMed  Google Scholar 

  • Singh H, Nugent Z, Demers AA, et al. Rate and predictors of early/missed colorectal cancers after colonoscopy in Manitoba: a population-based study. Am J Gastroenterol. 2010a;105:2588–96.

    Article  PubMed  Google Scholar 

  • Singh H, Nugent Z, Mahmud SM, et al. Predictors of colorectal cancer after negative colonoscopy: a population-based study. Am J Gastroenterol. 2010b;105:663–73. quiz 674

    Article  PubMed  Google Scholar 

  • The National Bowel Cancer Screening Program Quality Working Group. Improving colonoscopy services in Australia. Australian Government Department of Health and Ageing, Canberra 2009.

    Google Scholar 

  • van Doorn SC, van Vliet J, Fockens P, et al. A novel colonoscopy reporting system enabling quality assurance. Endoscopy. 2014;46:181–7.

    Article  PubMed  Google Scholar 

  • Wang HS, Pisegna J, Modi R, et al. Adenoma detection rate is necessary but insufficient for distinguishing high versus low endoscopist performance. Gastrointest Endosc. 2013;77:71–8.

    Article  PubMed  Google Scholar 

  • Wong JCT, Chiu HM, Kim HS, et al. Adenoma detection rates in colonoscopies for positive fecal immunochemical tests versus direct screening colonoscopies. Gastrointest Endosc. 2019;89:607–13. e1

    Article  PubMed  Google Scholar 

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  1. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Han-Mo Chiu

  2. Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Han-Mo Chiu

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Correspondence to Han-Mo Chiu .

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  1. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Han-Mo Chiu

  2. Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health National Taiwan University, Taipei, Taiwan

    Hsiu-Hsi Chen

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Chiu, HM. (2021). Quality Assurance in Colorectal Cancer Screening Program. In: Chiu, HM., Chen, HH. (eds) Colorectal Cancer Screening. Springer, Singapore. https://doi.org/10.1007/978-981-15-7482-5_7

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