Original article
Alimentary tract
Variation of Adenoma Prevalence by Age, Sex, Race, and Colon Location in a Large Population: Implications for Screening and Quality Programs

https://doi.org/10.1016/j.cgh.2012.09.010Get rights and content

Background & Aims

Reliable community-based colorectal adenoma prevalence estimates are needed to inform colonoscopy quality standards and to estimate patient colorectal cancer risks; however, minimal data exist from populations with large numbers of diverse patients and examiners.

Methods

We evaluated the prevalence of adenomas detected by sex, age, race/ethnicity, and colon location among 20,792 Kaiser Permanente Northern California members ≥50 years of age who received a screening colonoscopy examination (102 gastroenterologists, 2006–2008).

Results

Prevalence of detected adenomas increased more rapidly with age in the proximal colon (adjusted odds ratio [OR], 2.39; 95% confidence interval [CI], 2.05–2.80; 70–74 vs 50–54 years) than in the distal colon (OR, 1.89; 95% CI, 1.63–2.19). Prevalence was higher among men vs women at all ages (OR, 1.77; 95% CI, 1.66–1.89), increasing in men from 25% to 39% at ≥70 years and in women from 15% at 50–54 years to 26% (P < .001). Proximal adenoma prevalence was higher among blacks than whites (OR, 1.26; 95% CI, 1.04–1.54), although total prevalence was similar, including persons <60 years old (OR, 1.17; 95% CI, 0.91–1.50).

Conclusions

Prevalence of detected adenomas increases substantially with age and is much higher in men; proximal adenomas are more common among blacks than whites, although the total prevalence and the prevalence for ages <60 years were similar by race. These demographic differences are such that current adenoma detection guidelines may not be valid, without adjustment, for comparing providers serving different populations. The variation in prevalence and location may also have implications for the effectiveness of screening methods in different demographic groups.

Section snippets

Setting

This is a retrospective cohort study among members of Kaiser Permanente Northern California, an integrated health services delivery organization that serves approximately 3.3 million people across 15 medical centers in urban, suburban, and semirural regions within a large geographic area. Its membership demographics closely approximate the diverse underlying population of Northern California, as compared with census demographics, including members with Medicare, Medicaid (low-income), and

Results

Between January 2006 and December 2008, we identified 20,792 screening colonoscopies among 125,462 total colonoscopy examinations performed for any indication for members ≥50 years of age. Examinations were excluded for the following reasons: diagnostic or surveillance examination indications (including history of an adenoma) (n = 73,922); colonoscopy within the previous 10 years, sigmoidoscopy within the previous 5 years, or a positive stool blood test within the previous year (n = 28,890);

Discussion

The success of colorectal cancer screening programs largely depends on the identification and removal of precancerous adenomas and early-stage cancers amenable to treatment. Prior publications have evaluated differences in colorectal cancer incidence by sex, age, and race/ethnicity; however, this article reports the detailed prevalence of detected colorectal adenomas at screening colonoscopy by patient demographics within a large multimedical center, community-based population with

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    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by grants from the Kaiser Permanente Community Benefits program and from the National Cancer Institute (U54 CA163262).

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