Original article
Alimentary tract
Development and Validation of a Scoring System to Identify Individuals at High Risk for Advanced Colorectal Neoplasms Who Should Undergo Colonoscopy Screening

https://doi.org/10.1016/j.cgh.2013.08.042Get rights and content

Background & Aims

Screening the population for colorectal cancer (CRC) by colonoscopy could reduce the disease burden. However, targeted screening of individuals at high risk could increase its cost effectiveness.

Methods

We developed a scoring system to identify individuals with at least 1 advanced adenoma, based on easy-to-collect risk factors among 7891 participants of the German screening colonoscopy program. The system was validated in an independent sample of 3519 participants. Multiple logistic regression was used to develop the algorithm, and the regression coefficient-based scores were used to determine individual risks. Relative risk and numbers of colonoscopies needed for detecting one or more advanced neoplasm(s) were calculated for quintiles of the risk score. The predictive ability of the scoring system was quantified by the area under the curve.

Results

We identified 9 risk factors (sex, age, first-degree relatives with a history of CRC, cigarette smoking, alcohol consumption, red meat consumption, ever regular use [at least 2 times/wk for at least 1 y] of nonsteroidal anti-inflammatory drugs, previous colonoscopy, and previous detection of polyps) that were associated significantly with risk of advanced neoplasms. The developed score was associated strongly with the presence of advanced neoplasms. In the validation sample, individuals in the highest quintile of scores had a relative risk for advanced neoplasm of 3.86 (95% confidence interval, 2.71–5.49), compared with individuals in the lowest quintile. The number needed to screen to detect 1 or more advanced neoplasm(s) varied from 20 to 5 between quintiles of the risk score. In the validation sample, the scoring system identified patients with CRC or any advanced neoplasm with area under the curve values of 0.68 and 0.66, respectively.

Conclusions

We developed a scoring system, based on easy-to-collect risk factors, to identify individuals most likely to have advanced neoplasms. This system might be used to stratify individuals for CRC screening.

Section snippets

Study Design and Study Population

Our study was performed among participants of the German screening colonoscopy program by linking self-reported information on CRC risk factors with findings at colonoscopy. Detailed information on the German screening colonoscopy program has been provided elsewhere.15 Briefly, colonoscopy was offered as a primary screening examination free of charge to the whole residents aged 55 years and older in Germany since 2002. Screening colonoscopy is conducted almost exclusively in practices of

Results

Overall, 7891 and 3519 participants of the screening colonoscopy were included in the derivation and validation samples, respectively. The most advanced finding at colonoscopy in the 2 samples was CRC in 107 (1.4%) and 29 (0.8%), advanced adenoma in 780 (9.9%) and 354 (10.1%), and other (nonadvanced) adenoma in 1815 (21.4%) and 750 (20.1%) participants, respectively. The prevalence of any advanced neoplasm was 11.2% and 10.9% in the derivation and validation samples, respectively.

The main

Discussion

In this analysis, we derived a scoring system to identify individuals at high risk for at least one advanced colorectal neoplasm from a large screening population based on some easy-to-collect information and validated it in an independent sample. Participants were classified into 5 risk categories (very low, low, intermediate, high, and very high) according to quintiles of the risk score. The risk of presence of at least one advanced neoplasm was about 4-fold higher in the top quintile than in

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    Conflicts of interest The author discloses no conflicts.

    Funding This study was supported in part by grants from the Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany. The sponsor had no role in the study design; in the collection, analysis, and interpretation of data; preparation; review; or approval of the manuscript.

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