Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study

ObjectiveScreening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers, leading to recommendations against its use for screening in some countries. This study aimed to determine whether, among average...

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Bibliographic Details
Published in:	Gut Vol. 67; no. 2; pp. 291 - 298
Main Authors:	Doubeni, Chyke A, Corley, Douglas A, Quinn, Virginia P, Jensen, Christopher D, Zauber, Ann G, Goodman, Michael, Johnson, Jill R, Mehta, Shivan J, Becerra, Tracy A, Zhao, Wei K, Schottinger, Joanne, Doria-Rose, V Paul, Levin, Theodore R, Weiss, Noel S, Fletcher, Robert H
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group 01.02.2018
Series:	Original article
Subjects:	Aged Aged, 80 and over California - epidemiology Case-Control Studies Colon, Ascending Colon, Descending Colon, Sigmoid Colon, Transverse Colonic Neoplasms - diagnostic imaging Colonic Neoplasms - mortality Colonic Neoplasms - pathology Colonoscopy - statistics & numerical data Early Detection of Cancer - statistics & numerical data Endoscopy Female Humans Male Middle Aged Rectal Neoplasms - diagnostic imaging Rectal Neoplasms - mortality Rectal Neoplasms - pathology Risk Factors Sigmoidoscopy - statistics & numerical data COLONOSCOPY COLORECTAL CANCER SCREENING ADENOCARCINOMA
ISSN:	0017-5749, 1468-3288, 1468-3288
Online Access:	Get full text
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Abstract	ObjectiveScreening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers, leading to recommendations against its use for screening in some countries. This study aimed to determine whether, among average-risk people, receipt of screening colonoscopy reduces the risk of dying from both right-colon and left-colon/rectal cancers.DesignWe conducted a nested case–control study with incidence-density matching in screening-eligible Kaiser Permanente members. Patients who were 55–90 years old on their colorectal cancer death date during 2006–2012 were matched on diagnosis (reference) date to controls on age, sex, health plan enrolment duration and geographical region. We excluded patients at increased colorectal cancer risk, or with prior colorectal cancer diagnosis or colectomy. The association between screening colonoscopy receipt in the 10-year period before the reference date and colorectal cancer death risk was evaluated while accounting for other screening exposures.ResultsWe analysed 1747 patients who died from colorectal cancer and 3460 colorectal cancer-free controls. Compared with no endoscopic screening, receipt of a screening colonoscopy was associated with a 67% reduction in the risk of death from any colorectal cancer (adjusted OR (aOR)=0.33, 95% CI 0.21 to 0.52). By cancer location, screening colonoscopy was associated with a 65% reduction in risk of death for right-colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53).ConclusionsScreening colonoscopy was associated with a substantial and comparably decreased mortality risk for both right-sided and left-sided cancers within a large community-based population.
AbstractList	Screening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers, leading to recommendations against its use for screening in some countries. This study aimed to determine whether, among average-risk people, receipt of screening colonoscopy reduces the risk of dying from both right-colon and left-colon/rectal cancers.OBJECTIVEScreening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers, leading to recommendations against its use for screening in some countries. This study aimed to determine whether, among average-risk people, receipt of screening colonoscopy reduces the risk of dying from both right-colon and left-colon/rectal cancers.We conducted a nested case-control study with incidence-density matching in screening-eligible Kaiser Permanente members. Patients who were 55-90 years old on their colorectal cancer death date during 2006-2012 were matched on diagnosis (reference) date to controls on age, sex, health plan enrolment duration and geographical region. We excluded patients at increased colorectal cancer risk, or with prior colorectal cancer diagnosis or colectomy. The association between screening colonoscopy receipt in the 10-year period before the reference date and colorectal cancer death risk was evaluated while accounting for other screening exposures.DESIGNWe conducted a nested case-control study with incidence-density matching in screening-eligible Kaiser Permanente members. Patients who were 55-90 years old on their colorectal cancer death date during 2006-2012 were matched on diagnosis (reference) date to controls on age, sex, health plan enrolment duration and geographical region. We excluded patients at increased colorectal cancer risk, or with prior colorectal cancer diagnosis or colectomy. The association between screening colonoscopy receipt in the 10-year period before the reference date and colorectal cancer death risk was evaluated while accounting for other screening exposures.We analysed 1747 patients who died from colorectal cancer and 3460 colorectal cancer-free controls. Compared with no endoscopic screening, receipt of a screening colonoscopy was associated with a 67% reduction in the risk of death from any colorectal cancer (adjusted OR (aOR)=0.33, 95% CI 0.21 to 0.52). By cancer location, screening colonoscopy was associated with a 65% reduction in risk of death for right-colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53).RESULTSWe analysed 1747 patients who died from colorectal cancer and 3460 colorectal cancer-free controls. Compared with no endoscopic screening, receipt of a screening colonoscopy was associated with a 67% reduction in the risk of death from any colorectal cancer (adjusted OR (aOR)=0.33, 95% CI 0.21 to 0.52). By cancer location, screening colonoscopy was associated with a 65% reduction in risk of death for right-colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53).Screening colonoscopy was associated with a substantial and comparably decreased mortality risk for both right-sided and left-sided cancers within a large community-based population.CONCLUSIONSScreening colonoscopy was associated with a substantial and comparably decreased mortality risk for both right-sided and left-sided cancers within a large community-based population. ObjectiveScreening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers, leading to recommendations against its use for screening in some countries. This study aimed to determine whether, among average-risk people, receipt of screening colonoscopy reduces the risk of dying from both right-colon and left-colon/rectal cancers.DesignWe conducted a nested case–control study with incidence-density matching in screening-eligible Kaiser Permanente members. Patients who were 55–90 years old on their colorectal cancer death date during 2006–2012 were matched on diagnosis (reference) date to controls on age, sex, health plan enrolment duration and geographical region. We excluded patients at increased colorectal cancer risk, or with prior colorectal cancer diagnosis or colectomy. The association between screening colonoscopy receipt in the 10-year period before the reference date and colorectal cancer death risk was evaluated while accounting for other screening exposures.ResultsWe analysed 1747 patients who died from colorectal cancer and 3460 colorectal cancer-free controls. Compared with no endoscopic screening, receipt of a screening colonoscopy was associated with a 67% reduction in the risk of death from any colorectal cancer (adjusted OR (aOR)=0.33, 95% CI 0.21 to 0.52). By cancer location, screening colonoscopy was associated with a 65% reduction in risk of death for right-colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53).ConclusionsScreening colonoscopy was associated with a substantial and comparably decreased mortality risk for both right-sided and left-sided cancers within a large community-based population. Screening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers, leading to recommendations against its use for screening in some countries. This study aimed to determine whether, among average-risk people, receipt of screening colonoscopy reduces the risk of dying from both right-colon and left-colon/rectal cancers. We conducted a nested case-control study with incidence-density matching in screening-eligible Kaiser Permanente members. Patients who were 55-90 years old on their colorectal cancer death date during 2006-2012 were matched on diagnosis (reference) date to controls on age, sex, health plan enrolment duration and geographical region. We excluded patients at increased colorectal cancer risk, or with prior colorectal cancer diagnosis or colectomy. The association between screening colonoscopy receipt in the 10-year period before the reference date and colorectal cancer death risk was evaluated while accounting for other screening exposures. We analysed 1747 patients who died from colorectal cancer and 3460 colorectal cancer-free controls. Compared with no endoscopic screening, receipt of a screening colonoscopy was associated with a 67% reduction in the risk of death from any colorectal cancer (adjusted OR (aOR)=0.33, 95% CI 0.21 to 0.52). By cancer location, screening colonoscopy was associated with a 65% reduction in risk of death for right-colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53). Screening colonoscopy was associated with a substantial and comparably decreased mortality risk for both right-sided and left-sided cancers within a large community-based population.
Author	Jensen, Christopher D Zhao, Wei K Levin, Theodore R Becerra, Tracy A Doubeni, Chyke A Weiss, Noel S Zauber, Ann G Fletcher, Robert H Johnson, Jill R Goodman, Michael Corley, Douglas A Mehta, Shivan J Doria-Rose, V Paul Quinn, Virginia P Schottinger, Joanne
AuthorAffiliation	6 Division of Gastroenterology, Department of Medicine, Perelman School of Medicine , University of Pennsylvania , Philadelphia, Pennsylvania , USA 5 Department of Epidemiology , Emory University , Atlanta, Georgia , USA 3 Department of Research & Evaluation , Kaiser Permanente Southern California , Pasadena, California , USA 2 Division of Research , Kaiser Permanente Northern California , Oakland, California , USA 9 Department of Population Medicine , Harvard Medical School , Boston, Massachusetts , USA 7 Division of Cancer Control and Population Sciences , National Cancer Institute, National Institutes of Health , Bethesda, Maryland , USA 1 Department of Family Medicine and Community Health , The Abramson Cancer Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania , USA 4 Department of Epidemiology & Biostatistics , Memorial Sloan Kettering Cancer Center , New York, New York , USA 8 Department of Epid
AuthorAffiliation_xml	– name: 8 Department of Epidemiology , University of Washington , Seattle, Washington , USA – name: 7 Division of Cancer Control and Population Sciences , National Cancer Institute, National Institutes of Health , Bethesda, Maryland , USA – name: 2 Division of Research , Kaiser Permanente Northern California , Oakland, California , USA – name: 1 Department of Family Medicine and Community Health , The Abramson Cancer Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania , USA – name: 4 Department of Epidemiology & Biostatistics , Memorial Sloan Kettering Cancer Center , New York, New York , USA – name: 5 Department of Epidemiology , Emory University , Atlanta, Georgia , USA – name: 6 Division of Gastroenterology, Department of Medicine, Perelman School of Medicine , University of Pennsylvania , Philadelphia, Pennsylvania , USA – name: 3 Department of Research & Evaluation , Kaiser Permanente Southern California , Pasadena, California , USA – name: 9 Department of Population Medicine , Harvard Medical School , Boston, Massachusetts , USA
Author_xml	– sequence: 1 givenname: Chyke A orcidid: 0000-0001-7495-0285 surname: Doubeni fullname: Doubeni, Chyke A email: Chyke.Doubeni@uphs.upenn.edu organization: Department of Family Medicine and Community Health, The Abramson Cancer Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA – sequence: 2 givenname: Douglas A surname: Corley fullname: Corley, Douglas A email: Chyke.Doubeni@uphs.upenn.edu organization: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA – sequence: 3 givenname: Virginia P surname: Quinn fullname: Quinn, Virginia P email: Chyke.Doubeni@uphs.upenn.edu organization: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA – sequence: 4 givenname: Christopher D surname: Jensen fullname: Jensen, Christopher D email: Chyke.Doubeni@uphs.upenn.edu organization: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA – sequence: 5 givenname: Ann G surname: Zauber fullname: Zauber, Ann G email: Chyke.Doubeni@uphs.upenn.edu organization: Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA – sequence: 6 givenname: Michael surname: Goodman fullname: Goodman, Michael email: Chyke.Doubeni@uphs.upenn.edu organization: Department of Epidemiology, Emory University, Atlanta, Georgia, USA – sequence: 7 givenname: Jill R orcidid: 0000-0003-3831-7049 surname: Johnson fullname: Johnson, Jill R email: Chyke.Doubeni@uphs.upenn.edu organization: Department of Family Medicine and Community Health, The Abramson Cancer Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA – sequence: 8 givenname: Shivan J surname: Mehta fullname: Mehta, Shivan J email: Chyke.Doubeni@uphs.upenn.edu organization: Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA – sequence: 9 givenname: Tracy A surname: Becerra fullname: Becerra, Tracy A email: Chyke.Doubeni@uphs.upenn.edu organization: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA – sequence: 10 givenname: Wei K surname: Zhao fullname: Zhao, Wei K email: Chyke.Doubeni@uphs.upenn.edu organization: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA – sequence: 11 givenname: Joanne surname: Schottinger fullname: Schottinger, Joanne email: Chyke.Doubeni@uphs.upenn.edu organization: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA – sequence: 12 givenname: V Paul surname: Doria-Rose fullname: Doria-Rose, V Paul email: Chyke.Doubeni@uphs.upenn.edu organization: Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA – sequence: 13 givenname: Theodore R surname: Levin fullname: Levin, Theodore R email: Chyke.Doubeni@uphs.upenn.edu organization: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA – sequence: 14 givenname: Noel S surname: Weiss fullname: Weiss, Noel S email: Chyke.Doubeni@uphs.upenn.edu organization: Department of Epidemiology, University of Washington, Seattle, Washington, USA – sequence: 15 givenname: Robert H surname: Fletcher fullname: Fletcher, Robert H email: Chyke.Doubeni@uphs.upenn.edu organization: Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/27733426$$D View this record in MEDLINE/PubMed
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Snippet	ObjectiveScreening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon... Screening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers,...
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SubjectTerms	Aged Aged, 80 and over California - epidemiology Case-Control Studies Colon, Ascending Colon, Descending Colon, Sigmoid Colon, Transverse Colonic Neoplasms - diagnostic imaging Colonic Neoplasms - mortality Colonic Neoplasms - pathology Colonoscopy - statistics & numerical data Early Detection of Cancer - statistics & numerical data Endoscopy Female Humans Male Middle Aged Rectal Neoplasms - diagnostic imaging Rectal Neoplasms - mortality Rectal Neoplasms - pathology Risk Factors Sigmoidoscopy - statistics & numerical data
Title	Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study
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