Evidence map›Paper›PMID 34325674›Full record

ArticleBMC cancer2021

Overtreatment in nonmalignant lesions detected in a colorectal cancer screening program: a retrospective cohort study.

Joaquín Cubiella, Antía González, Raquel Almazán, Elena Rodríguez-Camacho, Raquel Zubizarreta, Isabel Peña-Rey Lorenzo

Open access · goldAbstract read
In one paragraph

Article in BMC cancer, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.4field-weighted citation impact, top 38% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 4 citations in OpenAlex.

  1. Article
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Joaquín CubiellaDepartment of Gastroenterology, Hospital Universitario de Ourense, Rúa Ramón Puga 52-56, 32003, Ourense, Spain. joaquin.cubiella.fernandez@sergas.es.ORCID http://orcid.org/0000-0002-9994-4831
Antía GonzálezDepartment of Preventive Medicine, Hospital Universitario de Ourense, Ourense, Spain.
Raquel AlmazánDirección Xeral de Saúde Pública, Conselleria de Sanidade, Santiago de Compostela, Spain.
Elena Rodríguez-CamachoDirección Xeral de Saúde Pública, Conselleria de Sanidade, Santiago de Compostela, Spain.
Raquel ZubizarretaDirección Xeral de Saúde Pública, Conselleria de Sanidade, Santiago de Compostela, Spain.
Isabel Peña-Rey LorenzoDirección Xeral de Saúde Pública, Conselleria de Sanidade, Santiago de Compostela, Spain.
Conselleria de Sanitat Universal i Salut Pública · ESCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas · ESComplejo Hospitalario de Ourense · ES

Funding

Academia Médico Quirúrgica of Ourense, Spain 2018-20Instituto de Salud Carlos III PI17/00837
6 · The paper itself

Abstract

backgroundAlthough colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study was to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it.

methodsWe included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019 in the Galician (Spain) CRC screening program. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist's adenoma detection rate (ADR) classified into quartiles and the hospital's complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI).

resultsWe included 15,707 patients in the analysis with high (19.9%), intermediate (26.9%) low risk (23.3%) adenomas and normal colonoscopy (29.9%) detected in the analyzed period. Colorectal surgery was performed in 162 patients (1.03, 95% CI 0.87-1.19), due to colonoscopy complications (0.02, 95% CI 0.00-0.05) and resection of colorectal benign lesions (1.00, 95% CI 0.85-1.16). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications and one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years = 1.57, 95% CI 1.11-2.23), sex (female = 2.10, 95% CI 1.52-2.91), the European guidelines classification (high risk = 67.94, 95% CI 24.87-185.59; intermediate risk = 5.63, 95% CI 1.89-16.80; low risk = 1.43; 95% CI 0.36-5.75), the endoscopist's ADR (Q4 = 0.44, 95% CI 0.28-0.68; Q3 = 0.44, 95% CI 0.27-0.71; Q2 = 0.71, 95% CI 0.44-1.14) and the hospital (tertiary = 0.54, 95% CI 0.38-0.79).

conclusionsIn a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are low, and related to age, sex, endoscopic findings, endoscopist's ADR and the hospital's complexity.

Indexed as

Medical OveruseAdultAgedColonic DiseasesColorectal NeoplasmsCombined Modality TherapyDisease ManagementFemaleHospitalizationHumansMaleMass ScreeningMiddle AgedPostoperative ComplicationsPublic Health SurveillanceSpainAdenoma detection rateColorectal cancerOvertreatmentScreeningSurgical resection

Identifiers

PMID34325674
PMCPMC8323280
OpenAlexW3184753061

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.