Trends in Adenoma Detection Rates During the First 10 Years of the German Screening Colonoscopy Program

Gastroenterology. 2015 Aug;149(2):356-66.e1. doi: 10.1053/j.gastro.2015.04.012. Epub 2015 Apr 22.


Background & aims: The adenoma detection rate (ADR) is an important quality indicator of screening colonoscopy; it is inversely associated with risk of interval cancers and colorectal cancer mortality. We assessed trends in the ADR in the first 10 years of the German screening colonoscopy program.

Methods: We calculated age-adjusted and age-specific detection rates of nonadvanced adenomas and advanced adenomas for each calendar year based on 4.4 million screening colonoscopies conducted from 2003 through 2012 and reported to the German screening colonoscopy registry.

Results: We observed a steady and strong increase in rate of detection of nonadvanced adenomas in both sexes and all age groups. Age-adjusted rates of detection of nonadvanced adenomas increased from 13.3% to 22.3% among men and from 8.4% to 14.9% among women. This increase was mostly due to an increase in detection rates of adenomas <0.5 cm, and it is partly explained by an innovation effect (higher ADRs among incoming colonoscopists than among leaving colonoscopists, and relatively stable ADRs among continuing colonoscopists). Only modest increases were observed in detection rates of advanced adenomas (from 7.4% to 9.0% among men, and from 4.4% to 5.2% among women) and colorectal cancer. In 2012, overall ADR reached 31.3% and 20.1% in men and women, respectively.

Conclusions: We observed a strong increase in ADRs from 2003 through 2012 in Germany. Although we cannot exclude the effects of secular trends in colorectal neoplasm prevalence, the observed increase was mainly the result of a steady increase in detection of nonadvanced adenomas (especially adenomas <0.5 cm). Further research should address potential implications for defining screening and surveillance intervals.

Keywords: Colon Cancer; Colorectal Neoplasms; Endoscopy; Prevention.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoma / diagnosis
  • Adenoma / epidemiology*
  • Adenoma / pathology
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Arabidopsis Proteins
  • Colonoscopy*
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / epidemiology*
  • Early Detection of Cancer / methods
  • Early Detection of Cancer / statistics & numerical data
  • Early Detection of Cancer / trends*
  • Female
  • Germany / epidemiology
  • Humans
  • Male
  • Mass Screening / methods
  • Mass Screening / statistics & numerical data
  • Mass Screening / trends*
  • Middle Aged
  • Nuclear Proteins
  • Prevalence
  • Risk Factors
  • Sex Factors
  • Time Factors


  • Arabidopsis Proteins
  • Nuclear Proteins
  • TIC protein, Arabidopsis