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Volume 8, Issue 3 , Pages 275-279, March 2010

Endoscopist Specialty Is Associated With Incident Colorectal Cancer After a Negative Colonoscopy

Linda Rabeneck
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Reprint requests Address requests for reprints to: Linda Rabeneck, MD, MPH, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-025, Toronto, Ontario M4N 3M5, Canada. fax: (416) 480-5804
Lawrence F. Paszat
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

published online 02 November 2009.

Background & Aims

The incidence of colorectal cancer (CRC) is reduced for at least 10 years after a negative colonoscopy, compared with the general population. However, CRCs do occur in individuals after a negative colonoscopy. We investigated whether the colonoscopy volume and specialty of the endoscopists who perform the exam are associated with CRC after a negative complete colonoscopy.

Methods

A cohort of Ontario residents, 50–80 years old, who had a negative complete colonoscopy between January 1, 1992, and December 31, 1997, was identified by using linked administrative databases. Cohort members had no history of CRC or inflammatory bowel disease or a recent colonic resection. Each individual was followed through December 31, 2006, and those with a new diagnosis of CRC were identified. Multivariable analysis was used to evaluate the association of patient, endoscopist, and procedure setting characteristics with incident CRC.

Results

A cohort of 110,402 individuals with a negative complete colonoscopy was identified; the majority (86%) had their procedures performed in hospitals. During the 15-year follow-up period, 1596 (14.5%) developed CRC. There was no association between endoscopist colonoscopy volume and incident CRC. Among persons who had their colonoscopies at a hospital, those who had their procedures performed by a non-gastroenterologist were at significantly increased risk for developing subsequent CRC.

Conclusions

Endoscopist specialty is an important determinant of the effectiveness of colonoscopy in usual clinical practice. After a negative colonoscopy, those who have had their procedures performed by a gastroenterologist are less likely to develop CRC.

Keywords: Endoscopist, Colonoscopy, Colorectal Cancer

Abbreviations used in this paper: CI, confidence interval, CIHI, Canadian Institute for Health Information, CRC, colorectal cancer, HCN, health card number, HR, hazard ratio, ICD-9-CM, International Classification of Diseases-ninth revision-Clinical Modification, OCR, Ontario Cancer Registry, OHIP, Ontario Health Insurance Plan, RPDB, Registered Persons Database