http://www.ncbi.nlm.nih.gov/pubmed/23632815

Cancer Epidemiol Biomarkers Prev. 2013 Apr 30. [Epub ahead of print]

Natural history of colorectal adenomas: Birth cohort analysis among 3.6 million participants of screening colonoscopy.

Brenner H, Altenhofen L, Stock C, Hoffmeister M.

Source

1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center.

Abstract

BACKGROUND:

Most colorectal cancers (CRCs) develop from adenomas. Knowledge of the natural history of colorectal adenomas, which is not directly observable for ethical reasons, is crucial for designing cost-effective CRC screening strategies.

METHODS:

We derived transition rates from carriage of non-advanced adenoma to carriage of advanced adenoma to carriage of CRC by sex and age in birth cohort analyses among 3,593,420 participants in the German screening colonoscopy program in 2003-2010.

RESULTS:

Transition rates from advanced adenoma to CRC carriage were similar in men and women, but monotonically and significantly increased with age. Estimated annual transition percentages (95% CI) in age groups 55-59, 60-64, 65-69, 70-74 and 75-79 were 2.6 (2.4, 2.9), 3.1 (2.8, 3.3), 3.8 (3.5, 4.1), 5.1 (4.8, 5.5) and 5.2 (4.6, 5.8) among men, and 2.5 (2.2, 2.7), 2.7 (2.4, 3.0), 3.8 (3.5, 4.1), 5.0 (4.5, 5.4) and 5.6 (4.9, 6.3) among women. Estimated annual transitions from carriage of non-advanced to carriage of advanced adenoma were in a narrow range from 3.6 to 4.7% for all age and sex groups.

CONCLUSIONS:

Despite low annual transition rates, cumulative transition rates from advanced adenoma to CRC carriage are expected to exceed 60%, 50% and 40% for age intervals 55-80, 65-80 and 70-80 years, respectively, in both sexes. Cumulative transition rates from non-advanced adenoma to CRC carriage are expected to be close to 30% for age interval 55-80, but less than 2% for age interval 75-80. Impact: Our results enhance the empirical basis for modelling CRC screening strategies.