Assessment of adenoma detection rate benchmarks in women versus men

Abstract

Background: Current guidelines suggest screening adenoma detection rates (ADRs) of 15% for average-risk women and 25% for average-risk men.

Objective: Determine average-risk screening ADRs and the prevalence of adenomas by location, size, shape, and degree of dysplasia in each sex.

Design: Post hoc analysis of prospectively collected data.

Setting: Academic center, ambulatory center.

Patients: A total of 864 average-risk patients.

Intervention: Screening colonoscopy.

Main outcome measurements: By using a prospectively collected colonoscopy database, we determined the ADRs for each sex and compared them to current medical society guidelines. In patients with adenomas detected, we compared the percentage of proximally located, large, and advanced-pathology adenomas between sexes.

Results: The overall average-risk screening ADR was 33.7% for both sexes combined. Average risks for women and men were significantly higher than guidelines (women: 25.4% vs 15%; P = .0003; men: 41.2% vs 25%; P < .0001). The ADR remained significantly higher for men versus women (P < .0001). Overall advanced-pathology adenoma detection was 12.2% for both sexes combined. There was a significantly higher advanced-pathology ADR for men (15.3%) versus women (8.7%) (P = .003). There was no significant difference between the sexes when age was considered in both advanced-pathology and average-risk ADRs.

Limitations: Data from the study focused on improving ADRs in an academic setting.

Conclusion: The ADR in our study was higher than current benchmarks for both sexes. In patients with at least one adenoma, advanced-pathology adenomas were detected equally among men and women. Although the benefits of achieving supra-benchmark ADRs are unknown, high ADRs may lead to more effective colonoscopy.