Long-Term Colorectal-Cancer Incidence and Mortality after Lower Endoscopy

Abstract

BACKGROUND Colonoscopy and sigmoidoscopy provide protection against colorectal cancer, but the magnitude and duration of protection, particularly against cancer of the proximal colon, remain uncertain. METHODS We examined the association of the use of lower endoscopy (updated biennially from 1988 through 2008) with colorectal-cancer incidence (through June 2010) and colorectal-cancer mortality (through June 2012) among participants in the Nurses’ Health Study and the Health Professionals Follow-up Study. RESULTS Among 88,902 participants followed over a period of 22 years, we documented 1815 incident colorectal cancers and 474 deaths from colorectal cancer. With endoscopy as compared with no endoscopy, multivariate hazard ratios for colorectal cancer were 0.57 (95% confidence interval [CI], 0.45 to 0.72) after polypectomy, 0.60 (95% CI, 0.53 to 0.68) after negative sigmoidoscopy, and 0.44 (95% CI, 0.38 to 0.52) after negative colonoscopy. Negative colonoscopy was associated with a reduced incidence of proximal colon cancer (multivariate hazard ratio, 0.73; 95% CI, 0.57 to 0.92). Multivariate hazard ratios for death from colorectal cancer were 0.59 (95% CI, 0.45 to 0.76) after screening sigmoidoscopy and 0.32 (95% CI, 0.24 to 0.45) after screening colonoscopy. Reduced mortality from proximal colon cancer was observed after screening colonoscopy (multivariate hazard ratio, 0.47; 95% CI, 0.29 to 0.76) but not after sigmoidoscopy. As compared with colorectal cancers diagnosed in patients more than 5 years after colonoscopy or without any prior endoscopy, those diagnosed in patients within 5 years after colonoscopy were more likely to be characterized by the CpG island methylator phenotype (CIMP) (multivariate odds ratio, 2.19; 95% CI, 1.14 to 4.21) and microsatellite instability (multivariate odds ratio, 2.10; 95% CI, 1.10 to 4.02). CONCLUSIONS Colonoscopy and sigmoidoscopy were associated with a reduced incidence of cancer of the distal colorectum; colonoscopy was also associated with a modest reduction in the incidence of proximal colon cancer. Screening colonoscopy and sigmoidoscopy were associated with reduced colorectal-cancer mortality; only colonoscopy was associated with reduced mortality from proximal colon cancer. Colorectal cancer diagnosed within 5 years after colonoscopy was more likely than cancer diagnosed after that period or without prior endoscopy to have CIMP and microsatellite instability. (Funded by the National Institutes of Health and others.)

Propofol to Increase Colorectal Cancer Screening in Portugal

“…10 Some may argue the lack of randomized clinical trials to support colonoscopy instead of sigmoidoscopy but the indirect evidence is quite significant and the strength of the evidence is increasing. [8][9][10] These studies support the guidelines that consider colonoscopy as the preferred method.…”

“…aspect in this setting, as screening colonoscopy is the number one endoscopic procedure and it has been shown to be effective in reducing both incidence and mortality of colorectal cancer (CCR). 8 CCR is the 3 rd most common cancer in the world and in Portugal. It is accountable for over 600000 deaths worldwide and 3800 -in Portugal alone, representing over 12000 lost life years, which is higher than breast cancer.…”

Endocuff assisted colonoscopy significantly increases sessile serrated adenoma detection in veterans

“…Colonoscopy prevents CRC with studies showing that the removal of adenomatous polyps reduces CRC mortality (3). Among the many colonoscopy quality measures, adenoma detection rate Many accessories have been created to increase the detection of polyps and improve ADR.…”

Screening strategies for colorectal cancer among patients with nonalcoholic fatty liver disease and family history

“…2 Screening was found to be effective in reducing CRC-related mortality by 33, 40 and 56% using fecal occult blood tests (FOBTs), flexible sigmoidoscopy (FS) and colonoscopy, respectively. 3,4 Guidelines from Western and Asian countries 5,6 recommend population-based CRC screening in average-risk subjects aged 50-75 years.…”