Post-colonoscopy colorectal cancers in privately insured patients in South Africa
DOI:
https://doi.org/10.7196/Keywords:
Post Colonoscopy Colorectal cancer, Interval Colorectal Cancer, Colorectal cancerAbstract
Background. Post-colonoscopy colorectal cancers (PCCRCs) are colorectal cancers (CRCs) that are diagnosed within 3 - 5 years of a colonoscopy where a cancer was not detected. Colonoscopy is the current gold standard for the diagnosis of colorectal cancer. The rate of PCCRC is an indicator of the quality of colonoscopy, because the aim of a high-quality colonoscopy is to detect CRCs and advanced adenomas.
Objective. To calculate the rate of PCCRC in a privately insured population in South Africa (SA).
Methods. Data were retrospectively obtained from the largest private health insurance company in SA. Patients diagnosed with CRC from the period of 1 January 2013 to 31 December 2019 were included. Patients who were members of the fund for <5 years prior to diagnosis were excluded. Patients with conditions predisposing to CRC were excluded from the study. Patients with CRC who had undergone colonoscopy 6 - 60 months prior to the diagnosis of CRC were defined as PCCRC. Patients diagnosed with CRC were identified by ICD-10 codes and from the oncology registry. Colonoscopies were identified by procedure codes.
Results. A diagnosis of CRC was made in 19 538 patients in the 7-year period. Following exclusions, 4 765 patients were included in this study for analysis. PCCRC was identified in 415 patients (8.72%) between 6 and 60 months, of whom 315 were identified between 6 and 36 months (6.61%). The median (interquartile range (IQR)) age in the overall study group presenting with CRC was 64 (53 - 73) years, with that of the PCCRC group (n=415) being higher at a median (IQR) age of 67(53 - 72) years when compared with the non-PCCRC group (n=4 350) of 64 (53 - 72) years (p=0.0002). Overall, 21.3% of CRC patients were aged ≤50 years, and 51.3% were male. The percentages of patients aged ≤50 years in the PCCRC v. non-PCCRC groups were 17.1% (n=71/415) and 21.7% (n=945/4 350), respectively (p=0.03). The gender ratio did not differ in the PCCRC group v. the non-PCCRC group. Rectal cancers were more likely to be present in the PCCRC group at 32.8% (n=136/415) v. the non-PCCRC group at 24% (n=1 043/4 350) (p<0.001). In the PCCRC subset, 73.8% of colonoscopies were performed by surgeons, 13.4% by gastroenterologists and 12.8% by physicians and general practioners/others. The PCCRC rate was 14.4% for gastroenterologists and 7.9% for surgeons.
Conclusion. This study is the first study from SA to analyse PCCRC. The overall PCCRC rate was 6.61%, in line with published series.
References
1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods, and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136(5):E359-E386. https://doi. org/10.1002/ijc.29210
2. National Institute for Communicable Diseases. National Cancer Registry. https//www.nicd.ac.za/wp- content/uploads/2021/12/NCR_ Path_2019_ Full_ Report_ 8dec2021.pdf (accessed 5 February 2023).
3. Motsuku L, Chen WC, Muchengeti MM, et al. Colorectal cancer incidence and mortality trends by sex and population group in South Africa: 2002 - 2014. BMC Cancer 2021;21(1):129. https://doi.
org/10.1186/s12885-021-07853-1
4. O’Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst 2004;96(19):1420-1425. https://doi. org/10.1093/jnci/djh275
5. Shaukat A, Church TR, Mandel JS. Guaiac fecal occult blood test and reduction in colorectal cancer incidence. Clin Gastroenterol Hepatol 2021;19(10):2217. https://doi.org/10.1016/j.cgh.2021.05.008
6. QuinteroE,CastellsA,BujandaL,etal.Colonoscopyversusfecalimmunochemicaltestingincolorectal-
cancer screening. N Engl J Med 2012;366(8):697-706. https://doi.org/10.1056/nejmoa1108895
7. Day DW. The adenoma-carcinoma sequence. Scand J Gastroenterol Suppl 1984;104:99-107.
8. Leslie A, Carey FA, Pratt NR, Steele RJC. The colorectal adenoma-carcinoma sequence. Br J Surg
2002;89(7):845-860. https://doi.org/10.1046/j.1365-2168.2002. 02120.x
9. Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK. ACG Clinical guidelines: Colorectal
cancer screening 2021. Am J Gastroenterol 2021;116(3):458-479. https://doi.org/10.14309/
ajg.0000000000001122
10. BaxterNN,GoldwasserMA,PaszatLF,SaskinR,UrbachDR,RabeneckL.Associationofcolonoscopy and death from colorectal cancer. Ann Intern Med 2009;150(1):1-8. https://doi.org/10.7326/0003- 4819-150-1-200901060-00306
11. Logan RFA, Patnick J, Nickerson C, et al. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut 2012;61(10):1439-1446. https://doi.org/10.1136/ gutjnl-2011-300843
12. Singh H, Turner D, Xue L, Targownik LE, Bernstein CN. Risk of developing colorectal cancer following a negative colonoscopy examination: Evidence for a 10-year interval between colonoscopies. JAMA 2006;295(20):2366-2373. https://doi.org/10.1001/jama.295.20.2366
13. Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012;366(8):687-696. https://doi.org/10.1056/NEJMoa1100370 14. Anderson JC, Butterly LF. Colonoscopy: Quality indicators. Clin Transl Gastroenterol 2015;6(2):e77.
https://doi.org/10.1038/ctg.2015.5
15. Burr N, Valori R. National post-colonoscopy colorectal cancer data challenge services to improve quality of colonoscopy. Endosc Int Open 2019;07(05):E728-E729. https://doi.org/10.1055/a-0809-5233 16. Kumar S, Thosani N, Ladabaum U, et al. Adenoma miss rates associated with a 3-minute versus 6-minute colonoscopy withdrawal time: A prospective, randomised trial. Gastrointest Endosc
2017;85(6):1273-1280. https://doi.org/10.1016/j.gie.2016.11.030
17. Byers T, Levin B, Rothenberger D, Dodd GD, Smith RA. American Cancer Society guidelines for
screening and surveillance for early detection of colorectal polyps and cancer: Update 1997. American Cancer Society Detection and Treatment Advisory Group on Colorectal Cancer. CA Cancer J Clin 47(3):154-160. https://doi.org/10.3322/canjclin.47.3.154
18. Rutter MD, Beintaris I, Valori R, et al. World Endoscopy Organization consensus statements on post- colonoscopy and post-imaging colorectal cancer. Gastroenterology 2018;155(3):909-925.e3. https:// doi.org/10.1053/j.gastro.2018.05.038
19. Sawhney MS, Farrar WD, Gudiseva S, et al. Microsatellite instability in interval colon cancers. Gastroenterology 2006;131(6):1700-1705. https://doi.org/10.1053/j.gastro.2006.10.022
20. Arain MA, Sawhney M, Sheikh S, et al. CIMP status of interval colon cancers: Another piece to the puzzle. Am J Gastroenterol 2010;105(5):1189-1195. https://doi.org/10.1038/ajg.2009.699
21. Stoffel EM, Erichsen R, Frøslev T, et al. Clinical and molecular characteristics of post-colonoscopy colorectal cancer: A population-based study. Gastroenterology 2016;151(5):870-878.e3. https://doi. org/10.1053/j.gastro.2016.07.010
22. Sanduleanu S, Rutter MD. Interval colorectal cancers in inflammatory bowel disease. Gastrointest Endosc Clin N Am 2014;24(3):337-348. https://doi.org/10.1016/j.giec.2014.03.001
23. Tollivoro TA, Jensen CD, Marks AR, et al. Index colonoscopy-related risk factors for postcolonoscopy colorectal cancers. Gastrointest Endosc 2019;89(1):168-176.e3. https://doi.org/10.1016/j.gie.2018.08.023 24. Singh S, Singh PP, Murad MH, Singh H, Samadder JN. Prevalence, risk factors, and outcomes of interval
colorectal cancers: A systematic review and meta-analysis. Am J Gastroenterol 2014;109(9):1375-1389.
https://doi.org/10.1038/ajg.2014.171
25. Mazurek M, Murray A, Heitman SJ, et al. Association between endoscopist specialty and colonoscopy quality: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2022;20(9):1931-1946. https://doi.org/10.1016/j.cgh.2021.08.029
26. Kang JH-E, Evans N, Singh S, Samadder NJ, Lee JK. Systematic review with meta-analysis: The prevalence of post-colonoscopy colorectal cancers using the World Endoscopy Organization nomenclature. Aliment Pharmacol Ther 2021;54(10):1232-1242. https://doi.org/10.1111/apt.16622
27. Stoffel EM, Erichsen R, Frøslev T, et al. Clinical and molecular characteristics of post-colonoscopy colorectal cancer: A population-based study. Gastroenterology 2016;151(5):870-878.e3. https://doi. org/10.1053/j.gastro.2016.07.010
28. Yamaguchi H, Fukuzawa M, Minami H, et al. the relationship between post-colonoscopy colorectal cancer and quality indicators of colonoscopy: The latest single-center cohort study with a review of the literature. Internal Med 2020;59(12):1481-1488. https://doi.org/10.2169/internalmedicine.4212-19
29. LeClercqCMC,BouwensMWE,RondaghEJA,etal.Postcolonoscopycolorectalcancersarepreventable: A population-based study. Gut 2014;63(6):957-963. https://doi.org/10.1136/gutjnl-2013-304880
30. Prevost TC, Launoy G, Duffy SW, Chen HH. Estimating sensitivity and sojourn time in screening for colorectal cancer: A comparison of statistical approaches. Am J Epidemiol 1998;148(6):609-619. https://doi.org/10.1093/oxfordjournals.aje.a009687
31. Morris EJA, Rutter MD, Finan PJ, Thomas JD, Valori R. Post-colonoscopy colorectal cancer (PCCRC) rates vary considerably depending on the method used to calculate them: A retrospective observational population-based study of PCCRC in the English National Health Service. Gut 2015;64(8):1248-1256. https://doi.org/10.1136/gutjnl-2014-308362
32. Forsberg A, Widman L, Bottai M, Ekbom A, Hultcrantz R. Postcolonoscopy colorectal cancer in Sweden from 2003 to 2012: Survival, tumor characteristics, and risk factors. Clin Gastroenterol Hepatol 2020;18(12):2724-2733.e3. https://doi.org/10.1016/j.cgh.2020.06.010
33. Samadder NJ, Curtin K, Tuohy TMF, et al. Characteristics of missed or interval colorectal cancer and patient survival: A population-based study. Gastroenterology 2014;146(4):950-960. https://doi. org/10.1053/j.gastro.2014.01.013
34. Mueller M, Schneider MA, Deplazes B, Cabalzar-Wondberg D, Rickenbacher A, Turina M. Colorectal cancer of the young displays distinct features of aggressive tumor biology: A single-center cohort study. World J Gastrointestinal Surg 2021;13(2):164-175. https://doi.org/10.4240/wjgs.v13.i2.164
35. Kocián P, Svobodová I, Krejčí D, et al. Is colorectal cancer a more aggressive disease in young patients? A population-based study from the Czech Republic. Cancer Epidemiol 2019;63: 101621. https://doi. org/10.1016/J.CANEP.2019.101621
Downloads
Published
Issue
Section
License
Copyright (c) 2024 R Fourie, D Bizos, D Kruger
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
