Document Detail

Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study.
MedLine Citation:
PMID:  23460054     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The effectiveness of screening colonoscopy in average-risk adults is uncertain, particularly for right colon cancer.
OBJECTIVE: To examine the association between screening colonoscopy and risk for incident late-stage colorectal cancer (CRC).
DESIGN: Nested case-control study.
SETTING: Four U.S. health plans.
PATIENTS: 1039 average-risk adults enrolled for at least 5 years in one of the health plans. Case patients were aged 55 to 85 years on their diagnosis date (reference date) of stage IIB or higher (late-stage) CRC during 2006 to 2008. One or 2 control patients were selected for each case patient, matched on birth year, sex, health plan, and prior enrollment duration.
MEASUREMENTS: Receipt of CRC screening 3 months to 10 years before the reference date, ascertained through medical record audits. Case patients and control patients were compared on receipt of screening colonoscopy or sigmoidoscopy by using conditional logistic regression that accounted for health history, socioeconomic status, and other screening exposures.
RESULTS: In analyses restricted to 471 eligible case patients and their 509 matched control patients, 13 case patients (2.8%) and 46 control patients (9.0%) had undergone screening colonoscopy, which corresponded to an adjusted odds ratio (AOR) of 0.29 (95% CI, 0.15 to 0.58) for any late-stage CRC, 0.36 (CI, 0.16 to 0.80) for right colon cancer, and 0.26 (CI, 0.06 to 1.11; P = 0.069) for left colon/rectum cancer. Ninety-two case patients (19.5%) and 173 control patients (34.0%) had screening sigmoidoscopy, corresponding to an AOR of 0.50 (CI, 0.36 to 0.70) overall, 0.79 (CI, 0.51 to 1.23) for right colon late-stage cancer, and 0.26 (CI, 0.14 to 0.48) for left colon cancer.
LIMITATION: The small number of screening colonoscopies affected the precision of the estimates.
CONCLUSION: Screening with colonoscopy in average-risk persons was associated with reduced risk for diagnosis of incident late-stage CRC, including right-sided colon cancer. For sigmoidoscopy, this association was seen for left CRC, but the association for right colon late-stage cancer was not statistically significant.
Chyke A Doubeni; Sheila Weinmann; Kenneth Adams; Aruna Kamineni; Diana S M Buist; Arlene S Ash; Carolyn M Rutter; V Paul Doria-Rose; Douglas A Corley; Robert T Greenlee; Jessica Chubak; Andrew Williams; Aimee R Kroll-Desrosiers; Eric Johnson; Joseph Webster; Kathryn Richert-Boe; Theodore R Levin; Robert H Fletcher; Noel S Weiss
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Annals of internal medicine     Volume:  158     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-05     Completed Date:  2013-05-06     Revised Date:  2013-09-10    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  312-20     Citation Subset:  AIM; IM    
Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Gates 2, Philadelphia, PA 19104, USA.
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MeSH Terms
Aged, 80 and over
Case-Control Studies
Colonoscopy* / economics
Colorectal Neoplasms / diagnosis*,  pathology,  prevention & control
Early Detection of Cancer* / economics
Logistic Models
Mass Screening* / economics
Middle Aged
Neoplasm Staging
Risk Factors
Sensitivity and Specificity
Grant Support
K01 CA127118/CA/NCI NIH HHS; K01-CA127118/CA/NCI NIH HHS; K01-CA127118-S1/CA/NCI NIH HHS; K05 CA092002/CA/NCI NIH HHS; N01-CN-67009/CN/NCI NIH HHS; N01-PC-35142/PC/NCI NIH HHS; R01 CA151736/CA/NCI NIH HHS; RC2 CA148576/CA/NCI NIH HHS; U01 CA151736/CA/NCI NIH HHS; U01-CA151736/CA/NCI NIH HHS; UC2 CA148576/CA/NCI NIH HHS; UC2CA148576/CA/NCI NIH HHS
Comment In:
MMW Fortschr Med. 2013 May 16;155(9):33   [PMID:  23951654 ]
Summary for patients in:
Ann Intern Med. 2013 Mar 5;158(5 Pt 1):I-48   [PMID:  23460070 ]

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