Index stratifies risk for advanced colorectal neoplasia
Thomas F. Imperiale, M.D., from the Indiana University School of Medicine in Indianapolis, and colleagues conducted a cross-sectional study to create a risk index for advanced neoplasia anywhere in the colorectum, using the most common risk factors for colorectal neoplasia. Data were included for persons aged 50 to 80 years undergoing initial screening colonoscopy.
The researchers found that the prevalence of advanced neoplasia was 9.4 percent among 2,993 persons in the derivation set. For people classified as being at very low, low, intermediate, and high risk, the risks for advanced neoplasia were 1.92, 4.88, 9.93, and 24.9 percent, respectively (P < 0.001). In the low-risk groups, sigmoidoscopy to the descending colon would have detected 73 percent of advanced neoplasms. The corresponding risks for advanced neoplasia were 1.65, 3.31, 10.9, and 22.3 percent, respectively, among the 1,467 persons in the validation set (P < 0.001). Sigmoidoscopy would have detected 87.5 percent of advanced neoplasms.
"The score may be useful in counseling average-risk patients about their risk for colorectal cancer," writes the author of an accompanying editorial. "But until stronger scientific evidence is available, I would not recommend such scores for choosing the type of screening test an average-risk person should have."
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