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Predictors of Colorectal Cancer Following a Negative Colonoscopy in the Medicare Population

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Abstract

Background

The incidence of colorectal cancer following a normal colonoscopy in the Medicare population is not known.

Methods

A 5% national sample of Medicare enrollees from 1996 to 2005 was used to identify patients undergoing complete colonoscopy. A colonoscopy not associated with any procedure (e.g., biopsy, polypectomy or fulguration) was defined as a negative colonoscopy. Patients with history of inflammatory bowel disease, colorectal cancer or death within 12 months of colonoscopy were excluded. A multivariable model was constructed to evaluate the factors associated with a new diagnosis of colorectal cancer in the period from 12 to 120 months following the negative colonoscopy.

Results

Among 200,857 patients (mean age 74 years, 61% female, 92% White) with a negative colonoscopy, the incidence of colorectal cancer was 1.8 per 1,000 person-years. The incidence rate for matched follow-up periods decreased from 2.0/1,000 person-years for patients undergoing colonoscopy during 1996–2000 to 1.2/1,000 person years during 2001–2005. Multivariate analysis revealed a significant regional variation in the incidence of colorectal cancer following a negative colonoscopy. The incidence was higher in patients >85 years, males and patients who underwent a negative colonoscopy by a non-gastroenterologist or endoscopist in the lowest volume quartile. On stratified analyses, endoscopist volume was a significant predictor for non-gastroenterologists only.

Conclusions

The specialty and experience of the endoscopist are significant predictors of the incidence rate of colorectal cancer in Medicare patients with a negative colonoscopy.

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Conflict of interest

Authors have no conflicts of interest.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, University of Texas Medical Branch (UTMB), 301 University Blvd., Galveston, TX, 77555-0764, USA

    Amanpal Singh

  2. Sealy Center on Aging, University of Texas Medical Branch (UTMB), Galveston, TX, USA

    Amanpal Singh, Yong-Fang Kuo, Taylor S. Riall & James S. Goodwin

  3. Department of Surgery, University of Texas Medical Branch (UTMB), Galveston, TX, USA

    Taylor S. Riall

  4. Departments of Gastroenterology, Hepatology and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    G. S. Raju

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  1. Amanpal Singh
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  2. Yong-Fang Kuo
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  3. Taylor S. Riall
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  4. G. S. Raju
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  5. James S. Goodwin
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Correspondence to Amanpal Singh.

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Singh, A., Kuo, YF., Riall, T.S. et al. Predictors of Colorectal Cancer Following a Negative Colonoscopy in the Medicare Population. Dig Dis Sci 56, 3122–3128 (2011). https://doi.org/10.1007/s10620-011-1788-6

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  • DOI: https://doi.org/10.1007/s10620-011-1788-6

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