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Prevention, Early Detection, and Overdiagnosis of Colorectal Cancer Within 10 Years of Screening Colonoscopy in Germany

  • Hermann Brenner
    Correspondence
    Reprint requests Address correspondence to: Hermann Brenner, MD, MPH, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, D-69120 Heidelberg, Germany. fax: +49-6221-421302.
    Affiliations
    Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany

    German Cancer Consortium (DKTK), Heidelberg, Germany
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  • Lutz Altenhofen
    Affiliations
    Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
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  • Christian Stock
    Affiliations
    Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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  • Michael Hoffmeister
    Affiliations
    Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Published:September 10, 2014DOI:https://doi.org/10.1016/j.cgh.2014.08.036

      Background & Aims

      Screening colonoscopy was introduced in Germany in October 2002. We aimed to quantify its effects on prevention, early detection, and overdiagnosis of colorectal cancer (CRC) in the 10 years since its introduction.

      Methods

      We analyzed data from more than 4.4 million screening colonoscopies (conducted on individuals 55–79 years old from 2003 through 2012) available through the national screening colonoscopy registry. CRCs prevented, detected earlier than they would have been without screening, and overdiagnosed (cancers detected at screening colonoscopy that would not have become clinically manifest during the patient’s lifetime) were estimated by Markov models. Model parameters included sex-specific and age-specific findings at screening colonoscopy; mortality; rates of transition from nonadvanced to advanced adenoma, advanced adenoma to preclinical cancer, or preclinical cancer to clinically manifest cancer; and protection from screening colonoscopy.

      Results

      Overall, approximately 180,000 CRCs (1/28 screening colonoscopies) were estimated to have been prevented, and more than 40,000 CRCs (1/121 screening colonoscopies) were detected earlier than they would have been without screening, compared with approximately 4500 overdiagnoses (1/1089 screening colonoscopies). Almost all CRCs prevented or detected earlier than they would have been without screening resulted from screening colonoscopies performed on individuals up to 75 years old (97% and 89%, respectively), whereas 28% of overdiagnoses occurred from screening colonoscopies of individuals older than 75 years old.

      Conclusions

      On the basis of a 10-year analysis of data from a national registry in Germany, screening colonoscopies have large potential for prevention and early detection of CRC, with low risk of overdiagnosis.

      Keywords

      Abbreviations used in this paper:

      CRC (colorectal cancer), SHI (statutory health insurance)
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