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Background & AimsColonoscopy is used widely for colorectal cancer (CRC) screening; however, its long-term impact on the incidence and mortality of CRC is not known. MethodsWe assessed CRC incidence and mortality in a group of asymptomatic average-risk patients who underwent screening colonoscopy between 1989 and 1993 at a university hospital. By using standardized incidence ratios and standardized mortality ratios, we compared our observed CRC rates with expected rates from the Surveillance, Epidemiology, and End Results (SEER) data. ResultsThe cohort comprised 715 patients (mean age, 61 ± 6.5 y; 59% male; 95% Caucasian) with 10,492 patient-years of follow-up. There were 12 cases of CRC: 5 found at baseline and 7 found after a median follow-up period of 8 years (range, 3–16 y). When the first 2 years of follow-up were excluded, there were 7 incident cases of CRC (95% confidence interval [CI], 2–13) over 9075 person-years of follow-up. The expected number based on SEER data was 21. The incidence rate was 0.77 cases per 1000 person-years, and the standardized incidence ratio was 0.33 (95% CI, 0.10–0.62), consistent with a relative risk reduction in CRC incidence of 67%. Three patients died from CRC (95% CI, 0–9). The expected number of deaths based on SEER data was 9. The mortality rate was 0.29 per 1000 person-years, and the standardized mortality ratio was 0.35 (95% CI, 0.0–1.06), consistent with a relative reduction in CRC death of 65%. ConclusionsIn this average-risk cohort, CRC incidence and mortality were reduced after screening colonoscopy. These results provide additional evidence for the effectiveness of colonoscopy as a primary CRC screening modality. Abbreviations used in this paper: CI, confidence interval, CRC, colorectal cancer, SEER, Surveillance, Epidemiology, and End Results, SIR, standardized incidence ratio ⁎ Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana ‡ The Richard L. Roudebush VA Medical Center, Indiana University, Indianapolis, Indiana § Regenstrief Institute, Inc, Indiana University, Indianapolis, Indiana ¶ Department of Biostatistics, Indiana University, Indianapolis, Indiana
To view this article's video abstract, go to the AGA's YouTube Channel. This article has an accompanying continuing medical education activity on page 711. Learning Objectives—After completing this CME activity, the learner should be able to understand the public impact of colon cancer in the United States and to study the impact of colonoscopy and polypectomy on colon cancer incidence and mortality. Conflicts of interest The authors disclose no conflicts. Funding Supported in part by National Institutes of Health grant K24 DK02756 (to T.F.I.). PII: S1542-3565(09)00006-8 doi:10.1016/j.cgh.2008.12.030 © 2009 AGA Institute. Published by Elsevier Inc. All rights reserved.
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ABSTRACT
Effect of Screening Colonoscopy on Colorectal Cancer Incidence and Mortality