The role of endoscopist adenoma detection rate in in sex differences in colonoscopy findings: cross-sectional analysis of the SCREESCO randomized controlled trial

Fewer adenomas are detected at colonoscopy in women compared to men and failure to detect adenomas and sessile serrated polyps is associated with an increased risk of post-colonoscopy colorectal cancer. The aim of this study was to investigate whether this was in part due to the greater difficulty of conducting colonoscopy in women, with the difference being more apparent in colonoscopies conducted by less skilled endoscopists. Cross-sectional exploratory analysis of data on 16,551 individuals undergoing a primary colonoscopy (PCOL group) or colonoscopy after positive faecal immunochemical test (FIT group) within the randomized controlled trial SCREESCO. Endoscopist adenoma detection rate (ADR; low or high) was determined based on each endoscopist’s colonoscopies performed in SCREESCO. In each study group, the relationship between the sex difference in colonoscopy outcome and endoscopist ADR was assessed using multiplicative interaction tests. Endoscopists performed equally many colonoscopies in men and women (median 52% men). There were no signs of effect modification of the risk ratio of any finding (men vs women) by endoscopist ADR in the PCOL group (p = 0.33) or the FIT group (p = 0.30). The proportion of incomplete index colonoscopies was lower in men than in women in both groups and there was no effect modification by endoscopist ADR in either the PCOL group (p = 0.41) or the FIT group (p = 0.96). This study provides no evidence that endoscopist skill measured by ADR underlies the sex difference in adenoma detection at colonoscopy. This study has trial number NCT02078804 and is registered with ClinicalTrials.gov.</p

The effect of prognostic factors on early breast cancer survival.

1<p>Adjusted for year at diagnosis, lymph node status and oncological treatment.</p>2<p>Adjusted for year at diagnosis, tumour size and oncological treatment.</p>3<p>Adjusted for year at diagnosis, stage and oncological treatment.</p><p>Effect on survival of women aged 20–69 years, diagnosed with primary breast cancer stage I-IIb between 1992 and 2005 (18 631 women), adjusted by year of diagnosis, stage at diagnosis and oncological treatment (radiotherapy, chemotherapy, and endocrine therapy) and stratified on tumour characteristics.</p

Breast cancer survival by age and stage at diagnosis.

<p>Cumulative 5-year RSR and the estimated RER and 95% CI by stage at diagnosis of women aged 20–69 years, diagnosed with primary breast cancer of all stages between 1992 and 2005 (22 017 women).</p

Treatments given to women with stage I breast cancer by age and tumour size.

<p>Proportions of women aged 20–69 years, diagnosed with primary breast cancer stage I between 1992 and 2005 (9656 women), receiving specific treatments, by tumour size and age at diagnosis.</p

Ten year cumulative survival in relation to expected survival (RSR) according to age and stage of women aged 20–69 years, diagnosed with primary breast cancer between 1992 and 2005 (22 017 women).

<p>Size of the groups as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0007695#pone-0007695-t003" target="_blank">Table 3</a>. A: Stage I, B: Stage IIa, C: Stage IIb, D: Stage III, E: Stage IV.</p

Cumulative 5-year relative survival ratio (RSR) and the estimated relative excess risks of mortality (RER) by age.

<p>The deviance is a measure of the models goodness-of-fit. Under the hypothesis that the model fits, the deviance should follow a chi-square distribution with the specified degrees of freedom).</p>2<p>Likelihood ratio test of the effect of age in the model; df = 3, chi-square = 96.7, p<0.0001.</p>3<p>Model adjusted for year (1992–93, 1994–95, 1996–97, 1998–99, 2000–01, 2002–03, 2004–05) and stage (I, IIa, IIb, III, IV, undefined). Likelihood ratio test of the effect of age in the model; df = 3, chi-square = 33.5, p<0.0001.</p>4<p>Deviance 26, Residual df 12.</p>5<p>Deviance 945, Residual df 760.</p><p>Cumulative 5-year relative survival ratio (RSR) and the estimated relative excess risks of mortality (RER) by age with 95% confidence intervals (CI) of women 20–69 years, diagnosed with primary breast cancer of all stages between 1992 and 2005 (22 017 women).</p

The combined effect of prognostic factors and treatment on breast cancer stage I-IIb.

<p>Model 1: Crude.</p><p>Model 2: Adjusted for year of diagnosis (1992–93, 1994–95, 1996–97, 1998–99, 2001–01, 2002–03, 2004–05).</p><p>Model 3: Adjusted for year of diagnosis, tumour stage (tumour size, lymph node status).</p><p>Model 4: Adjusted for year of diagnosis, all tumour characteristics (tumour size, lymph node status, tumour grade, hormone receptor status, multifocality).</p><p>Model 5: Adjusted for year of diagnosis, all tumour characteristics and treatment (preoperative treatment, type of surgery, radiotherapy, chemotherapy and endocrine therapy).</p><p>Estimated RER with 95% CI for women aged 20–69 years, diagnosed with primary breast cancer stage I-IIb between 1992 and 2005 (18 631 women), by age at diagnosis, adjusted for year of diagnosis, tumour stage, tumour characteristics and treatment.</p

Cumulative mortality from BCa, other cancer and cardiovascular disease by the highest and lowest categories of CRP, AGC and G/L ratio.

<p>Gray’s test for equality of cumulative incidence functions was performed in presence of competing risks.</p