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

Hermann Brenner ^1*, Michael Hoffmeister ¹, Christa Stegmaier ², Gerhard Brenner ³, Lutz Altenhofen ³ and Ulrike Haug ¹

¹ German Cancer Research Center, Germany
² Saarland Cancer Registry, Germany
³ Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland, Germany

^* To whom correspondence should be addressed. E-mail: h.brenner{at}dkfz-heidelberg.de.

Accepted 31 May 2007

Abstract

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 program 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+)

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 to 5.6% in age group 80+ among women, and from 2.6% in age group 55-59 to 5.1% in age group 80+ among men). Projections of 10-year cumulative risk increase from 25.4% at age 55 to 42.9% at age 80 in women, and from 25.2% at age 55 to 39.7% at age 80 among 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 programs.

Keywords: adenoma, colonoscopy, colorectal cancer, progression, screening

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