Paszat Lawrence, Sutradhar Rinku, Luo Jin, Tinmouth Jill, Rabeneck Linda, Baxter Nancy N
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Cancer Research Programme, Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.
J Can Assoc Gastroenterol. 2021 Jun 10;5(2):86-95. doi: 10.1093/jcag/gwab014. eCollection 2022 Apr.
Persons suspected or confirmed with familial colorectal cancer syndrome are recommended to have biennial colonoscopy from late adolescence or early adulthood. Persons without a syndrome but with one or more affected first-degree relatives are recommended to begin colonoscopy 10 years before the age at diagnosis of the youngest affected relative, and every 5 to 10 years. Ontario introduced colonoscopy billing codes for these two indications in 2011.
We identified persons in Ontario under 50 years of age, without a prior history of colorectal cancer or inflammatory bowel disease, with one or more of these billing claims between 2013 and 2017. We described the index colonoscopy, and subsequent colonoscopy up-to-date status. We computed average annual rates of colorectal and other cancer diagnoses, and displayed mean cumulative function plots, stratified by billing code, age and sex.
Billing claims for 'familial syndrome' high-risk screening colonoscopy were identified among 14,846 persons; the average annual rate of CRC diagnoses was 38.6 per 100,000 among males and 22.2 among females. Colonoscopy up-to-date status fell to 50% within 7 years. Billing claims for 'first-degree relative' screening colonoscopy was identified among 49,505 persons; average annual rates of CRC diagnoses were 16.3 among males and 13.5 per 100,000 among females, respectively.
Colorectal cancer was more frequent following billing claims for high-risk screening colonoscopy for familial syndromes, as were noncolorectal malignancies potentially associated with these syndromes. This billing claim for familial colorectal cancer syndrome colonoscopy appears to identify a group at elevated short-term risk for cancer.
疑似或确诊患有家族性结直肠癌综合征的患者，建议从青春期后期或成年早期开始每两年进行一次结肠镜检查。没有该综合征但有一个或多个一级亲属患病的人，建议在最年轻患病亲属确诊年龄前10年开始结肠镜检查，之后每5至10年进行一次。安大略省于2011年引入了针对这两种情况的结肠镜检查计费代码。
我们在安大略省识别出年龄在50岁以下、无结直肠癌或炎症性肠病病史、在2013年至2017年间有一项或多项此类计费记录的人员。我们描述了首次结肠镜检查情况以及后续结肠镜检查的最新状态。我们计算了结直肠癌和其他癌症诊断的年均发生率，并绘制了按计费代码、年龄和性别分层的平均累积函数图。
在14846人中发现了“家族综合征”高危筛查结肠镜检查的计费记录；男性结直肠癌诊断的年均发生率为每10万人38.6例，女性为22.2例。结肠镜检查最新状态在7年内降至50%。在49505人中发现了“一级亲属”筛查结肠镜检查的计费记录；男性结直肠癌诊断的年均发生率分别为每10万人16.3例，女性为13.5例。
在因家族综合征进行高危筛查结肠镜检查计费后，结直肠癌更为常见，与这些综合征潜在相关的非结直肠癌恶性肿瘤也是如此。这种家族性结直肠癌综合征结肠镜检查的计费记录似乎识别出了一组短期癌症风险升高的人群。
