Imperial College London
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Professor Amanda Cross

Faculty of Medicine, School of Public Health

Professor of Cancer Epidemiology
 
 
 
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Contact

 

+44 (0)20 7594 3338amanda.cross

 
 
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Assistant

 

Mr Will Kay +44 (0)20 7594 3350

 
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Location

 

Room 1089Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Pinsky:2018:10.1053/j.gastro.2018.06.040,
author = {Pinsky, PF and Loberg, M and Senore, C and Wooldrage, K and Atkin, W and Bretthauer, M and Cross, AJ and Hoff, G and Holme, O and Kalager, M and Segnan, N and Schoen, RE},
doi = {10.1053/j.gastro.2018.06.040},
journal = {Gastroenterology},
pages = {1059--1068.e2},
title = {Number of adenomas removed and colorectal cancers prevented in randomized trials of flexible sigmoidoscopy screening},
url = {http://dx.doi.org/10.1053/j.gastro.2018.06.040},
volume = {155},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background & AimsScreening for colorectal cancer (CRC) with sigmoidoscopy reduces CRC incidence by detecting and removing adenomas. The number needed to screen is a measure of screening efficiency, but is not directly associated with adenoma removal. We propose 2 new metrics for quantifying the relationship between adenoma removal and CRC prevented: number of adenomas needed to remove (NNR) and adenoma dwell time avoided (DTA).MethodsWe collected data from 4 randomized trials of sigmoidoscopy screening (in the United States and 3 in Europe) to assess NNR and DTA. For each trial, NNR was computed as the number of adenomas removed from subjects in the intervention group divided by the number of CRCs prevented. DTA was computed similarly but taking into account the timing of adenoma removal. Combined results across trials were assessed using standard meta-analytic techniques.ResultsThe estimated NNR for the PLCO trial was 74 (95% CI, 56–110), for the NORCCAP trial was 71 (95% CI, 44–174), for the SCORE trial was 27 (95% CI, 14–135), and for the UKFSST trial was 36 (95% CI, 28–52). The combined estimate (meta-analysis) of NNR was 52 (95% CI, 36–93) assuming heterogeneity (P for heterogeneity=.014). DTA estimates among trials ranged from 278 to 730 years, with a combined estimate of 500 years (95% CI, 344–833 years) assuming heterogeneity (P for heterogeneity=.035), or 2 CRC cases prevented per 1000 adenoma dwell years avoided. The combined estimates of NNR and DTA restricted to advanced adenomas were 13 (95% CI, 9–22) and 122 years (95% CI, 90–190), respectively.ConclusionsWe collected data from 4 randomized trials of sigmoidoscopy screening for CRC to develop metrics endoscopic efficiency, NNR and DTA, that are directly linked to adenoma detection and removal. They can be used to compare screening among endoscopic modalities and to more precisely measure adenoma to carcinoma transition rates.
AU  - Pinsky,PF
AU  - Loberg,M
AU  - Senore,C
AU  - Wooldrage,K
AU  - Atkin,W
AU  - Bretthauer,M
AU  - Cross,AJ
AU  - Hoff,G
AU  - Holme,O
AU  - Kalager,M
AU  - Segnan,N
AU  - Schoen,RE
DO  - 10.1053/j.gastro.2018.06.040
EP  - 1068
PY  - 2018///
SN  - 0016-5085
SP  - 1059
TI  - Number of adenomas removed and colorectal cancers prevented in randomized trials of flexible sigmoidoscopy screening
T2  - Gastroenterology
UR  - http://dx.doi.org/10.1053/j.gastro.2018.06.040
UR  - http://hdl.handle.net/10044/1/61585
VL  - 155
ER  -
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