Digestive Diseases and Sciences

, Volume 56, Issue 11, pp 3122–3128

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

  • Amanpal Singh
  • Yong-Fang Kuo
  • Taylor S. Riall
  • G. S. Raju
  • James S. Goodwin
Stanford Multidisciplinary Seminars

DOI: 10.1007/s10620-011-1788-6

Cite this article as:
Singh, A., Kuo, YF., Riall, T.S. et al. Dig Dis Sci (2011) 56: 3122. doi:10.1007/s10620-011-1788-6

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.

Keywords

Colonoscopy Colon cancer Missed diagnosis Diagnostic errors Regional variation 

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Amanpal Singh
    • 1
    • 2
  • Yong-Fang Kuo
    • 2
  • Taylor S. Riall
    • 2
    • 3
  • G. S. Raju
    • 4
  • James S. Goodwin
    • 2
  1. 1.Division of Gastroenterology, Department of Internal MedicineUniversity of Texas Medical Branch (UTMB)GalvestonUSA
  2. 2.Sealy Center on AgingUniversity of Texas Medical Branch (UTMB)GalvestonUSA
  3. 3.Department of SurgeryUniversity of Texas Medical Branch (UTMB)GalvestonUSA
  4. 4.Departments of Gastroenterology, Hepatology and NutritionUniversity of Texas M.D. Anderson Cancer CenterHoustonUSA

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