Colorectal cancer

Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840 149 screening colonoscopies

Hermann Brenner¹, Michael Hoffmeister¹, Christa Stegmaier², Gerhard Brenner³, Lutz Altenhofen³ and Ulrike Haug¹

¹ Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
² Saarland Cancer Registry, Saarbrücken, Germany
³ Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland, Berlin, Germany

Correspondence to:
Hermann Brenner, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Bergheimer Str. 20, D-69115 Heidelberg, Germany; h.brenner{at}dkfz-heidelberg.de

Objectives: To derive age and sex specific estimates of transition rates from advanced adenomas to colorectal cancer by combining data of a nationwide screening colonoscopy registry and national data on colorectal cancer (CRC) incidence.

Design: Registry based study.

Setting: National screening colonoscopy programme in Germany.

Patients: Participants of screening colonoscopy in 2003 and 2004 (n = 840 149).

Main outcome measures: Advanced adenoma prevalence, colorectal cancer incidence, annual and 10 year cumulative risk of developing CRC among carriers of advanced adenomas according to sex and age (range 55–80+ years)

Results: The age gradient is much stronger for CRC incidence than for advanced adenoma prevalence. As a result, projected annual transition rates from advanced adenomas to CRC strongly increase with age (from 2.6% in age group 55–59 years to 5.6% in age group 80 years among women, and from 2.6% in age group 55–59 years to 5.1% in age group 80 years among men). Projections of 10 year cumulative risk increase from 25.4% at age 55 years to 42.9% at age 80 years in women, and from 25.2% at age 55 years to 39.7% at age 80 years in men.

Conclusions: Advanced adenoma transition rates are similar in both sexes, but there is a strong age gradient for both sexes. Our estimates of transition rates in older age groups are in line with previous estimates derived from small case series in the pre-colonoscopy era independent of age. However, our projections for younger age groups are considerably lower. These findings may have important implications for the design of CRC screening programmes.

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