Risk of Colorectal Cancer After Colonoscopy Compared With Flexible Sigmoidoscopy or No Lower Endoscopy Among Older Patients in the United States, 1998-2005

Wang, Yize R.; Cangemi, John R.; Loftus, Edward V.; Picco, M.F.

doi:10.1016/j.mayocp.2012.12.012

Cited by 11 publications

(17 citation statements)

References 32 publications

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“…Our study period coincided with Medicare coverage of screening colonoscopy and the subsequent rise in colonoscopy use [14]. Our measured risk reductions associated with colonoscopy in these elderly patients were in line with prior studies of younger patients and elderly US veterans, with a larger risk reduction in the distal colon [8,9,10,11,13]. …”

Section: Discussionsupporting

confidence: 68%

“…If a patient underwent more than one colonoscopy, the date of the first colonoscopy identified during this period was used in the estimation of CRC risk after colonoscopy. A patient diagnosed with CRC within 6 months of colonoscopy was assumed to have undergone a diagnostic colonoscopy [5,6,7,8,9,11] and excluded from the study group.…”

Section: Methodsmentioning

confidence: 99%

“…In the United States (US), colonoscopy is the preferred method to screen for colorectal cancer (CRC) [1,2] and it has been associated with a reduced incidence of CRC, with a smaller effect in the proximal colon than the distal colon [3,4,5,6,7,8,9,10,11]. The incidence of CRC rises with age [1,2,12].…”

Section: Introductionmentioning

confidence: 99%

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Decreased Risk of Colorectal Cancer after Colonoscopy in Patients 76-85 Years Old in the United States

Wang

Cangemi

Loftus³

et al. 2015

Digestion

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Background/Aims: The benefits of colonoscopy in reducing colorectal cancer (CRC) risk for patients over 75 years are controversial. We aimed to determine whether colonoscopy use is associated with a decreased risk of CRC in patients 76-85 years old in the United States (US). Patients and Methods: All patients in the Medicare 5% random sample of the Surveillance, Epidemiology and End Results-Medicare linked database 76-85 years old at outpatient colonoscopy between January 1, 1998 and December 31, 2002 were identified. Using the Kaplan-Meier method, we estimated the cumulative incidence of CRC in the above-mentioned colonoscopy group and compared with the control group of patients without colonoscopy. All patients were followed until diagnosis of CRC or carcinoma in situ, death or December 31, 2005. The multivariate Cox proportional hazards model was used in statistical analysis. CRC was separated by location into distal vs. proximal CRC in subgroup analysis. Results: Of 5,701 patients in the colonoscopy group, 37 (0.65%) patients were diagnosed with CRC, compared to 379 (1.55%) out of 24,437 patients in the control group (p < 0.001). The cumulative incidences of distal and proximal CRC were lower in the colonoscopy group compared to those in the control group (5-year distal CRC: 0.26 vs. 0.77%; 5-year proximal CRC: 0.43 vs. 0.79%, both p < 0.05). In multivariate Cox regression, colonoscopy was associated with decreased risk of all CRC (hazard ratio ((HR) 0.42, 95% CI 0.28-0.65), distal CRC (HR 0.36, 95% CI 0.18-0.70), and proximal CRC (HR 0.53, 95% CI 0.30-0.92)). Conclusion: Among patients 76-85 years old in the United States, colonoscopy use was associated with decreased risks of both distal and proximal CRC, with a smaller risk reduction in distal colon. Due to inherent limitations associated with our retrospective design, future prospective studies are needed to validate these findings.

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Section: Discussionsupporting

confidence: 68%

Section: Methodsmentioning

confidence: 99%

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Decreased Risk of Colorectal Cancer after Colonoscopy in Patients 76-85 Years Old in the United States

Wang

Cangemi

Loftus³

et al. 2015

Digestion

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“…45 A recent analysis of a 5% random Medicare sample of the SEER database found a similar reduction in distal CRC after both colonoscopy and sigmoidoscopy, with a reduction in proximal CRC after colonoscopy but not sigmoidoscopy. 46 A similar result was seen in a nested case-control study of 4 US health plans, in which the reduction of stage IIB or higher CRC was only seen on the left side. 47 Compared with colonoscopy, sigmoidoscopy requires no sedation and less bowel preparation but is limited to examination of the lower half of the colon tract.…”

Section: Structural Screening Testssupporting

confidence: 68%

Colorectal Cancer Screening

Burt¹,

Cannon²,

David³

et al. 2013

J Natl Compr Canc Netw

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Mortality from colorectal cancer can be reduced by early diagnosis and by cancer prevention through polypectomy. These NCCN Guidelines for Colorectal Cancer Screening describe various colorectal screening modalities and recommended screening schedules for patients at average or increased risk of developing colorectal cancer. In addition, the guidelines provide recommendations for the management of patients with high-risk colorectal cancer syndromes, including Lynch syndrome. Screening approaches for Lynch syndrome are also described.

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“…[45,46] Studies, with the use of screening colonoscopy, have shown that more than 30% of patients with advanced neoplasia have proximal lesions that would not be identified with sigmoidoscopy alone. [47,48] The most performed indication for colonoscopy in the United States is for screening and surveillance purposes. Colonoscopy can detect a wide range of colon pathologies including polyps, angiodysplasias, hemorrhoids, and cancer.…”

Section: Structural Examinations Of the Colonmentioning

confidence: 99%

Screening and Surveillance Colonoscopy

Ayoola¹,

Abdulla²,

Brady³

et al. 2015

Screening for Colorectal Cancer With Colonoscopy

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Colorectal cancer is a major cause of worldwide morbidity and mortality. As such, there are many guidelines and recommendations set forth by various medical societies regarding colonoscopy for screening and surveillance. The universal goal of these guidelines is to reduce colorectal cancer prevalence and mortality. Recommendations for colorectal cancer screening and surveillance using colonoscopy vary slightly between medical society guidelines and are often dictated by some combination of age, known disease severity, length of time since last study, family history, and comorbid conditions.

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Risk of Colorectal Cancer After Colonoscopy Compared With Flexible Sigmoidoscopy or No Lower Endoscopy Among Older Patients in the United States, 1998-2005

Cited by 11 publications

References 32 publications

Decreased Risk of Colorectal Cancer after Colonoscopy in Patients 76-85 Years Old in the United States

Decreased Risk of Colorectal Cancer after Colonoscopy in Patients 76-85 Years Old in the United States

Colorectal Cancer Screening

Screening and Surveillance Colonoscopy

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