Rate and Predictors of Early/Missed Colorectal Cancers After Colonoscopy in Manitoba: A Population-Based Study

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OBJECTIVES:Many of the colorectal cancers (CRCs) diagnosed within 3 years after a colonoscopy are likely because of lesions missed on the initial colonoscopy. In this population-based study, we investigated the rate and predictors of CRCs diagnosed within 3 years of a colonoscopy.METHODS:We identified individuals 50–80 years of age diagnosed with CRC between 1992 and 2008 from the provincewide Manitoba Cancer Registry. Performance of colonoscopy and history of co-morbidities was determined by linkage to the provincial universal health care insurance provider's physician billing claims and hospital discharges databases. CRCs diagnosed within 6 months of a colonoscopy were categorized as detected CRCs and those 6–36 months after a colonoscopy as early/missed CRCs. Logistic regression analysis was performed to identify the patient, endoscopist, colonoscopy, and CRC factors associated with early/missed CRCs.RESULTS:Of the 4,883 CRCs included in the study, 388 (7.9%) were early/missed CRCs, with a range of 4.5% of rectum/rectosigmoid cancers in men to 14.4% of transverse colon/splenic flexure cancers in women. Independent risk factors associated with early/missed CRCs included prior colonoscopy, performance of index colonoscopy by family physicians, recent year of CRC diagnosis, and proximal site of CRC.CONCLUSIONS:This study suggests that approximately 1 in 13 CRCs may be an early/missed CRC, diagnosed after an index colonoscopy in usual clinical practice. Women are more likely to have early/missed CRC. It is unclear if this relates to differences in procedure difficulty, bowel preparation issues, or tumor biology between men and women.

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