Colonoscopy in Colorectal-Cancer Screening for Detection of Advanced Neoplasia

Reguła, Jarosław; Rupiński, Maciej; Kraszewska, Ewa; Polkowski, Marcin; Pachlewski, Jacek; Orłowska, Janina; Nowacki, Marek P.; Butruk, E

doi:10.1056/nejmoa054967

Cited by 709 publications

(595 citation statements)

References 25 publications

Supporting

Mentioning

488

Contrasting

Unclassified

Order By: Relevance

“…Our analysis suggests that the balance in favour of screening is likely to be reached several years later among women than among men. This finding is supported by a recent study from Poland among more than 50 000 participants of a colonoscopy-based screening programme, where prevalence of advanced adenomas was higher at each age among men than among women, prompting the authors to the conclusion that gender-specific CRC-screening recommendations may be warranted (Regula et al, 2006). Furthermore, there are indications both from our analysis and from the literature (Fernandez et al, 2001) that the gender difference in the epidemiology of CRC has steadily increased during the last few decades.…”

Section: Discussionmentioning

confidence: 68%

Gender differences in colorectal cancer: implications for age at initiation of screening

et al. 2007

View full text Add to dashboard Cite

There is some variation regarding age at initiation of screening for colorectal cancer (CRC) between countries, but the same age of initiation is generally recommended for women and men within countries, despite important gender differences in the epidemiology of CRC. We have explored whether, and to what extent, these differences would be relevant regarding age at initiation of CRC screening. Using population-based cancer registry data from the US and national mortality statistics from different countries, we looked at cumulative 10-year incidence and mortality of CRC reached among men at ages 50, 55, and 60, and found that women mainly reached equivalent levels when 4 to 8 years older. The gender differences were remarkably constant across populations and over time. These patterns suggest that gender differentiation of age at initiation may be worthwhile to utilise CRC-screening resources more efficiently. With more than one million new cases and more than 500 000 deaths per year, colorectal cancer (CRC) is the third commonest cancer and the fourth commonest cancer cause of death worldwide (Parkin et al, 2005). Owing to its typically slow development, there is a large potential for reducing the burden of the disease by early detection and removal of precancerous lesions or early cancer stages. Various screening examinations, including faecal occult blood testing (FOBT), sigmoidoscopy, and colonoscopy have meanwhile been recommended by expert committees and implemented in screening offers in a number of countries (e.g. Winawer et al, 2003;Schmiegel et al, 2004;Malila et al, 2005;Smith et al, 2006). Regarding the age at initiation of screening, which is a crucial parameter for the effectiveness and cost-effectiveness of screening programmes (Vijan et al, 2001), there is some variation between countries (typically ranging from 50 to 60 years for the population at average risk). However, within countries, the same age of initiation is generally recommended for women and men, despite important gender differences in the epidemiology of CRC. In particular, age-specific CRC incidence and mortality are lower in women than in men, which implies that women reach comparable levels of CRC incidence and mortality at higher ages than men. This paper aims to address the question whether and to what extent these epidemiological differences might be relevant for defining age at initiation of CRC screening among women and men. METHODS Outcome measureWhen attempting to translate the gender differences in the epidemiology of CRC into gender-specific ages at initiation of screening, it is first necessary to define an appropriate outcome measure. In a screening programme that primarily aims at the early detection of CRC, as applies to FOBT-based screening, (cumulative) age-and sex-specific CRC incidence appears to be a natural choice. In a screening programme that aims to detect both CRC and its precursors (adenomas), as applies to endoscopy-based screening, the epidemiology of adenomas might also be considered. However, if the time...

show abstract

Section: Discussionmentioning

confidence: 68%

Gender differences in colorectal cancer: implications for age at initiation of screening

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Future work should incorporate more refined clinical data to determine whether our decision rule is applicable in different settings. Second, more detailed information about variation in SC effectiveness as well as colonoscopy-associated death rates and non-fatal health outcomes, including quality of life and patient preferences, should be explored 47,48 . Third, future work should incorporate other determinants of cancer risk as well as alternate screening modalities, given evidence suggesting the benefits of flexible sigmoidoscopies in particular may be comparable to SC [49][50][51] .…”

Section: Discussionmentioning

confidence: 99%

Assessing the Impact of Screening Colonoscopy on Mortality in the Medicare Population

et al. 2011

View full text Add to dashboard Cite

“…Controls 1 During the past several years, the phrase "advanced neoplasia" has been used in several studies [6][7][8][9][10] to refer to the combination of adenocarcinoma and certain types of pre-malignant polyps, which include tubular adenomas 1 cm or larger, polyps with villous histology, and polyps with high-grade dysplasia. As such, "advanced neoplasia" is now, for better or for worse, the outcome by which studies of screening and surveillance are measured.…”

Section: Study Proceduresmentioning

confidence: 99%

Risk factors for advanced sporadic colorectal neoplasia in persons younger than age 50

Imperiale

Kahi

Stuart

et al. 2008

Cancer Detection and Prevention

View full text Add to dashboard Cite

Background-Colorectal cancer (CRC) screening is recommended for average risk adults beginning at age 50. However, 7% of CRC occurs in persons younger than age 50, a group for which risk factors are not well defined. We sought to determine whether a retrospective case-control study could identify risk factors for sporadic CRC and advanced adenomatous polyps (together known as sporadic colorectal neoplasia [CRN]).

show abstract

Colonoscopy in Colorectal-Cancer Screening for Detection of Advanced Neoplasia

Abstract: We detected advanced neoplasia at a significantly higher rate in men than in women, which may warrant refinement of the screening recommendations for colorectal cancer.

Cited by 709 publications

References 25 publications

Gender differences in colorectal cancer: implications for age at initiation of screening

Gender differences in colorectal cancer: implications for age at initiation of screening

Assessing the Impact of Screening Colonoscopy on Mortality in the Medicare Population

Risk factors for advanced sporadic colorectal neoplasia in persons younger than age 50

Contact Info

Product

Resources

About