Regula J et al. (2006) Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 355: 1863–1872

A new study has suggested that, along with age >49 years and family history of colorectal cancer, male sex is an important predictor of the detection of advanced neoplasia during colorectal screening. Regula and colleagues suggest that colonoscopy guidelines should, therefore, be refined to include this parameter.

Regula and colleagues performed a cross-sectional analysis of data from 50,148 patients (aged 40–66 years) who participated in a national, colonoscopy-based screening program in Poland. Multivariate logistic regression was used to identify associations between patient characteristics and advanced neoplasia in two-thirds of the cohort, and these associations were confirmed in the remainder. Advanced neoplasia (i.e. cancer or adenoma ≥10 mm in diameter, high-grade dysplasia, villous or tubulovillous histologic characteristics, or any combination thereof) was detected in 2,553 (5.9%) participants aged 50–66 years and in 243 (3.4%) participants aged 40–49 years. Analysis showed that male sex was independently associated with advanced neoplasia (odds ratio 1.73; 95% CI 1.52–1.98). This association remained after adjustment for colonoscopic factors, family history and age (odds ratio 1.98; 95% CI 1.83–2.14). The number needed to screen in order to detect one advanced neoplasia was markedly lower in men than in women of similar family history and age (for example, in the 40–49-year age-group, the number needed to screen was 23 in men and 36 in women).

The authors conclude that modification of colonoscopy screening recommendations would maximize the diagnostic yield of screening, and optimize resource use.