Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool

Laura W. Musselwhite, Thomas S. Redding, Kellie J. Sims, Meghan C. O'Leary, Elizabeth R. Hauser, Terry Hyslop, Ziad F. Gellad, Brian A. Sullivan, David Lieberman, Dawn Provenzale

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Adapting screening strategy to colorectal cancer (CRC) risk may improve efficiency for all stakeholders however limited tools for such risk stratification exist. Colorectal cancers usually evolve from advanced neoplasms that are present for years. We applied the National Cancer Institute (NCI) CRC Risk Assessment Tool, which calculates future risk of CRC, to determine whether it could be used to predict current advanced neoplasia (AN) in a veteran cohort undergoing a baseline screening colonoscopy. METHODS: This was a prospective assessment of the relationship between future CRC risk predicted by the NCI tool, and the presence of AN at screening colonoscopy. Family, medical, dietary and physical activity histories were collected at the time of screening colonoscopy and used to calculate absolute CRC risk at 5, 10 and 20 years. Discriminatory accuracy was assessed. RESULTS: Of 3121 veterans undergoing screening colonoscopy, 94% had complete data available to calculate risk (N = 2934, median age 63 years, 100% men, and 15% minorities). Prevalence of AN at baseline screening colonoscopy was 11 % (N = 313). For tertiles of estimated absolute CRC risk at 5 years, AN prevalences were 6.54% (95% CI, 4.99, 8.09), 11.26% (95% CI, 9.28-13.24), and 14.21% (95% CI, 12.02-16.40). For tertiles of estimated risk at 10 years, the prevalences were 6.34% (95% CI, 4.81-7.87), 11.25% (95% CI, 9.27-13.23), and 14.42% (95% CI, 12.22-16.62). For tertiles of estimated absolute CRC risk at 20 years, current AN prevalences were 7.54% (95% CI, 5.75-9.33), 10.53% (95% CI, 8.45-12.61), and 12.44% (95% CI, 10.2-14.68). The area under the curve for predicting current AN was 0.60 (95% CI; 0.57-0.63, p < 0.0001) at 5 years, 0.60 (95% CI, 0.57-0.63, p < 0.0001) at 10 years and 0.58 (95% CI, 0.54-0.61, p < 0.0001) at 20 years. CONCLUSION: The NCI tool had modest discriminatory function for estimating the presence of current advanced neoplasia in veterans undergoing a first screening colonoscopy. These findings are comparable to other clinically utilized cancer risk prediction models and may be used to inform the benefit-risk assessment of screening, particularly for patients with competing comorbidities and lower risk, for whom a non-invasive screening approach is preferred.

Original languageEnglish (US)
Number of pages1
JournalBMC cancer
Volume19
Issue number1
DOIs
StatePublished - Nov 12 2019

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National Cancer Institute (U.S.)
Veterans
Colonoscopy
Colorectal Neoplasms
Neoplasms
Area Under Curve
Comorbidity
Exercise

Keywords

  • Colorectal advanced neoplasia
  • Colorectal cancer screening
  • Risk assessment
  • Screening colonoscopy
  • Veteran

ASJC Scopus subject areas

  • Genetics
  • Oncology
  • Cancer Research

Cite this

Musselwhite, L. W., Redding, T. S., Sims, K. J., O'Leary, M. C., Hauser, E. R., Hyslop, T., ... Provenzale, D. (2019). Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool. BMC cancer, 19(1). https://doi.org/10.1186/s12885-019-6204-1

Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool. / Musselwhite, Laura W.; Redding, Thomas S.; Sims, Kellie J.; O'Leary, Meghan C.; Hauser, Elizabeth R.; Hyslop, Terry; Gellad, Ziad F.; Sullivan, Brian A.; Lieberman, David; Provenzale, Dawn.

In: BMC cancer, Vol. 19, No. 1, 12.11.2019.

Research output: Contribution to journalArticle

Musselwhite, LW, Redding, TS, Sims, KJ, O'Leary, MC, Hauser, ER, Hyslop, T, Gellad, ZF, Sullivan, BA, Lieberman, D & Provenzale, D 2019, 'Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool', BMC cancer, vol. 19, no. 1. https://doi.org/10.1186/s12885-019-6204-1
Musselwhite, Laura W. ; Redding, Thomas S. ; Sims, Kellie J. ; O'Leary, Meghan C. ; Hauser, Elizabeth R. ; Hyslop, Terry ; Gellad, Ziad F. ; Sullivan, Brian A. ; Lieberman, David ; Provenzale, Dawn. / Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool. In: BMC cancer. 2019 ; Vol. 19, No. 1.
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abstract = "BACKGROUND: Adapting screening strategy to colorectal cancer (CRC) risk may improve efficiency for all stakeholders however limited tools for such risk stratification exist. Colorectal cancers usually evolve from advanced neoplasms that are present for years. We applied the National Cancer Institute (NCI) CRC Risk Assessment Tool, which calculates future risk of CRC, to determine whether it could be used to predict current advanced neoplasia (AN) in a veteran cohort undergoing a baseline screening colonoscopy. METHODS: This was a prospective assessment of the relationship between future CRC risk predicted by the NCI tool, and the presence of AN at screening colonoscopy. Family, medical, dietary and physical activity histories were collected at the time of screening colonoscopy and used to calculate absolute CRC risk at 5, 10 and 20 years. Discriminatory accuracy was assessed. RESULTS: Of 3121 veterans undergoing screening colonoscopy, 94{\%} had complete data available to calculate risk (N = 2934, median age 63 years, 100{\%} men, and 15{\%} minorities). Prevalence of AN at baseline screening colonoscopy was 11 {\%} (N = 313). For tertiles of estimated absolute CRC risk at 5 years, AN prevalences were 6.54{\%} (95{\%} CI, 4.99, 8.09), 11.26{\%} (95{\%} CI, 9.28-13.24), and 14.21{\%} (95{\%} CI, 12.02-16.40). For tertiles of estimated risk at 10 years, the prevalences were 6.34{\%} (95{\%} CI, 4.81-7.87), 11.25{\%} (95{\%} CI, 9.27-13.23), and 14.42{\%} (95{\%} CI, 12.22-16.62). For tertiles of estimated absolute CRC risk at 20 years, current AN prevalences were 7.54{\%} (95{\%} CI, 5.75-9.33), 10.53{\%} (95{\%} CI, 8.45-12.61), and 12.44{\%} (95{\%} CI, 10.2-14.68). The area under the curve for predicting current AN was 0.60 (95{\%} CI; 0.57-0.63, p < 0.0001) at 5 years, 0.60 (95{\%} CI, 0.57-0.63, p < 0.0001) at 10 years and 0.58 (95{\%} CI, 0.54-0.61, p < 0.0001) at 20 years. CONCLUSION: The NCI tool had modest discriminatory function for estimating the presence of current advanced neoplasia in veterans undergoing a first screening colonoscopy. These findings are comparable to other clinically utilized cancer risk prediction models and may be used to inform the benefit-risk assessment of screening, particularly for patients with competing comorbidities and lower risk, for whom a non-invasive screening approach is preferred.",
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author = "Musselwhite, {Laura W.} and Redding, {Thomas S.} and Sims, {Kellie J.} and O'Leary, {Meghan C.} and Hauser, {Elizabeth R.} and Terry Hyslop and Gellad, {Ziad F.} and Sullivan, {Brian A.} and David Lieberman and Dawn Provenzale",
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TY - JOUR

T1 - Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool

AU - Musselwhite, Laura W.

AU - Redding, Thomas S.

AU - Sims, Kellie J.

AU - O'Leary, Meghan C.

AU - Hauser, Elizabeth R.

AU - Hyslop, Terry

AU - Gellad, Ziad F.

AU - Sullivan, Brian A.

AU - Lieberman, David

AU - Provenzale, Dawn

PY - 2019/11/12

Y1 - 2019/11/12

N2 - BACKGROUND: Adapting screening strategy to colorectal cancer (CRC) risk may improve efficiency for all stakeholders however limited tools for such risk stratification exist. Colorectal cancers usually evolve from advanced neoplasms that are present for years. We applied the National Cancer Institute (NCI) CRC Risk Assessment Tool, which calculates future risk of CRC, to determine whether it could be used to predict current advanced neoplasia (AN) in a veteran cohort undergoing a baseline screening colonoscopy. METHODS: This was a prospective assessment of the relationship between future CRC risk predicted by the NCI tool, and the presence of AN at screening colonoscopy. Family, medical, dietary and physical activity histories were collected at the time of screening colonoscopy and used to calculate absolute CRC risk at 5, 10 and 20 years. Discriminatory accuracy was assessed. RESULTS: Of 3121 veterans undergoing screening colonoscopy, 94% had complete data available to calculate risk (N = 2934, median age 63 years, 100% men, and 15% minorities). Prevalence of AN at baseline screening colonoscopy was 11 % (N = 313). For tertiles of estimated absolute CRC risk at 5 years, AN prevalences were 6.54% (95% CI, 4.99, 8.09), 11.26% (95% CI, 9.28-13.24), and 14.21% (95% CI, 12.02-16.40). For tertiles of estimated risk at 10 years, the prevalences were 6.34% (95% CI, 4.81-7.87), 11.25% (95% CI, 9.27-13.23), and 14.42% (95% CI, 12.22-16.62). For tertiles of estimated absolute CRC risk at 20 years, current AN prevalences were 7.54% (95% CI, 5.75-9.33), 10.53% (95% CI, 8.45-12.61), and 12.44% (95% CI, 10.2-14.68). The area under the curve for predicting current AN was 0.60 (95% CI; 0.57-0.63, p < 0.0001) at 5 years, 0.60 (95% CI, 0.57-0.63, p < 0.0001) at 10 years and 0.58 (95% CI, 0.54-0.61, p < 0.0001) at 20 years. CONCLUSION: The NCI tool had modest discriminatory function for estimating the presence of current advanced neoplasia in veterans undergoing a first screening colonoscopy. These findings are comparable to other clinically utilized cancer risk prediction models and may be used to inform the benefit-risk assessment of screening, particularly for patients with competing comorbidities and lower risk, for whom a non-invasive screening approach is preferred.

AB - BACKGROUND: Adapting screening strategy to colorectal cancer (CRC) risk may improve efficiency for all stakeholders however limited tools for such risk stratification exist. Colorectal cancers usually evolve from advanced neoplasms that are present for years. We applied the National Cancer Institute (NCI) CRC Risk Assessment Tool, which calculates future risk of CRC, to determine whether it could be used to predict current advanced neoplasia (AN) in a veteran cohort undergoing a baseline screening colonoscopy. METHODS: This was a prospective assessment of the relationship between future CRC risk predicted by the NCI tool, and the presence of AN at screening colonoscopy. Family, medical, dietary and physical activity histories were collected at the time of screening colonoscopy and used to calculate absolute CRC risk at 5, 10 and 20 years. Discriminatory accuracy was assessed. RESULTS: Of 3121 veterans undergoing screening colonoscopy, 94% had complete data available to calculate risk (N = 2934, median age 63 years, 100% men, and 15% minorities). Prevalence of AN at baseline screening colonoscopy was 11 % (N = 313). For tertiles of estimated absolute CRC risk at 5 years, AN prevalences were 6.54% (95% CI, 4.99, 8.09), 11.26% (95% CI, 9.28-13.24), and 14.21% (95% CI, 12.02-16.40). For tertiles of estimated risk at 10 years, the prevalences were 6.34% (95% CI, 4.81-7.87), 11.25% (95% CI, 9.27-13.23), and 14.42% (95% CI, 12.22-16.62). For tertiles of estimated absolute CRC risk at 20 years, current AN prevalences were 7.54% (95% CI, 5.75-9.33), 10.53% (95% CI, 8.45-12.61), and 12.44% (95% CI, 10.2-14.68). The area under the curve for predicting current AN was 0.60 (95% CI; 0.57-0.63, p < 0.0001) at 5 years, 0.60 (95% CI, 0.57-0.63, p < 0.0001) at 10 years and 0.58 (95% CI, 0.54-0.61, p < 0.0001) at 20 years. CONCLUSION: The NCI tool had modest discriminatory function for estimating the presence of current advanced neoplasia in veterans undergoing a first screening colonoscopy. These findings are comparable to other clinically utilized cancer risk prediction models and may be used to inform the benefit-risk assessment of screening, particularly for patients with competing comorbidities and lower risk, for whom a non-invasive screening approach is preferred.

KW - Colorectal advanced neoplasia

KW - Colorectal cancer screening

KW - Risk assessment

KW - Screening colonoscopy

KW - Veteran

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