In addition, initiatives to educate primary care physicians regarding the increasing risk of early-onset CRC are necessary to reduce persistent delays in diagnosis that result in premature morbidity and mortality in young, otherwise healthy and productive men and women. FUNDING SUPPORTNo specific funding was disclosed. CONFLICT OF INTEREST DISCLOSURESThe authors made no disclosures. REFERENCES 1. Abdelsattar ZM, Wong SL, Regenbogen SE, Jomaa DM, Hardiman KM, Hendren S. Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening.

Background Detection and removal of adenomas and clinically significant serrated polyps is critical to the effectiveness of colonoscopy in preventing colorectal cancer. While longer withdrawal time has been found to increase polyp detection, this association, and the use of withdrawal time as a quality indicator, remains controversial. Few studies have reported on withdrawal time and serrated polyp detection. Using data from the New Hampshire Colonoscopy Registry, we examined how an endoscopist’s withdrawal time in normal colonoscopies affects adenoma and serrated polyp detection. Methods We analyzed 7996 colonoscopies performed in 7972 patients between 2009 and 2011 by 42 endoscopists at 14 hospitals, ambulatory surgery centers, and community practices. Clinically significant serrated polyps (CSSPs) were defined as sessile serrated polyps and hyperplastic polyps proximal to the sigmoid. Adenoma and CSSP detection rates were calculated based on median endoscopist withdrawal time in normal exams. Regression models were used to estimate the association of increased normal withdrawal time and polyp, adenoma, and CSSP detection. Results Polyp and adenoma detection rates were highest among endoscopists with 9 minute median normal withdrawal time, while detection of CSSPs reached its highest levels at 8 to 9 minutes. Incident rate ratios for adenoma and CSSP detection increased with each minute of normal withdrawal time above 6 minutes, with maximum benefit at 9 minutes for adenomas (1.50, 95% CI (1.21,1.85)) and CSSPs (1.77, 95% CI (1.15, 2.72)). When modeling was used to set the minimum withdrawal time at 9 minutes, we predicted that adenomas and CSSPs would be detected in 302 (3.8%) and 191 (2.4%) more patients. The increase in detection was most striking for the CSSPs, with nearly a 30% relative increase. Conclusions A withdrawal time of 9 minutes resulted in a statistically significant increase in adenoma and serrated polyp detection. Colonoscopy quality may improve with a median normal withdrawal time benchmark of 9 minutes.

Background Persons with a family history (FH) of colorectal cancer (CRC) or adenomas that are not due to known hereditary syndromes have increased risk for CRC. Understanding these risks, screening recommendations and screening behaviors can inform strategies to reduce CRC burden in these families. Methods A comprehensive review of literature published within the past 10 years was conducted to assess what is known about cancer risk, screening guidelines, adherence and barriers to screening and effective interventions in persons with FH of CRC, and to identify FH tools used to identify these individuals and inform care. Results Existing data show that having one affected first-degree relative (FDR) increases CRC risk by 2-fold, and risk increases with multiple affected FDRs and younger age at diagnosis. There was variability in screening recommendations across consensus guidelines. Screening adherence was <50% and lower in persons under age 50. Having a provider’s recommendation, multiple affected relatives and family encouragement facilitated screening; insufficient collection of FH, low knowledge of guidelines, and poor family communication were important barriers. Effective interventions incorporated strategies for overcoming barriers but these have not been tested broadly in clinical settings. Conclusions Four strategies for reducing CRC in persons with familial risk are suggested: 1) improve how we collect and utilize cancer FH, 2) establish consensus for screening guidelines by FH, 3) enhance provider-patient knowledge of guidelines and communication about CRC risk, 4) encourage survivors to promote screening within their families, and partner with existing screening programs to expand reach to high-risk groups.

Background and Aims Similar to achieving adenoma detection rate (ADR) benchmarks to prevent colorectal cancer (CRC), achieving adequate serrated polyp detection rates (SDR) may be essential to the prevention of CRC associated with the serrated pathway. Previous studies have been based on data from high-volume endoscopists at single academic centers. Based on a hypothesis that ADR is correlated with SDR, we stratified a large, diverse group of endoscopists (n=77 practicing at 28 centers) into high and low performers based on ADR, to provide data for corresponding target SDR benchmarks. Methods Using colonoscopies in adults ≥ 50 years (4/09–12/14), we stratified endoscopists by high and low ADR (< 15%,15% to <25%,25% to <35%, ≥35%), to determine corresponding SDRs, using two SDR measures, for screening and surveillance colonoscopies separately: (1) Clinically significant SDR (CSSDR) = colonoscopies with any SSA/P, TSA, HP >1 cm anywhere in the colon or HP > 5 mm in the proximal colon only ÷ by total screening and surveillance colonoscopies, respectively. (2) Proximal SDR (PSDR) = colonoscopies with any serrated polyp (SSA/P, HP, TSA) of any size proximal to the sigmoid ÷ by total screening and surveillance colonoscopies, respectively. Results A total of 45,996 (29,960 screening) colonoscopies by 77 endoscopists (28 facilities) were included. Moderately strong positive correlation coefficients were observed for screening ADR/CSSDR (ρ=0.69) and ADR/PSDR (ρ=0.79) and a strong positive correlation (ρ=0.82) for CSSDR/PSDR (p<0.0001 for all). For ADR ≥25%, endoscopists’ median (IQR) screening CSSDR was 6.8% (4.3%–8.6%) and PSDR was 10.8% (8.6% –16.1%). Conclusion Derived from ADR, the primary colonoscopy quality indicator, our results suggest potential SDR benchmarks (CSSDR=7% and PSDR=11%) that may guide adequate serrated polyp detection. Because CSSDR and PSDR are strongly correlated, endoscopists could use the simpler PSDR calculation to assess quality.