Colorectal cancer mortality reduction is associated with having at least 1 colonoscopy within the previous 10 years among a population-wide cohort of screening age - 21/06/16
Abstract |
Background and Aims |
Colonoscopy has been demonstrated to be effective in colorectal cancer (CRC) mortality reduction, although current screening guidelines have yet to be evaluated. We assessed the protective benefit of colonoscopy within the previous 10 years and whether this effect is maintained with age.
Methods |
We used administrative data to compare risk of CRC death (CCD) across colonoscopy utilization among a population-wide cohort comprising individuals aged 60 to 80 years (N = 1,509,423). Baseline and time-dependent colonoscopy exposure models were assessed in the context of competing “other causes of death” (OCDs). Cumulative incidence of CCD and OCD across colonoscopy exposure, over follow-up, was estimated. Relative hazards were computed by age strata (60-69 years, 70-74 years, 75+ years) and proximal and distal cancer subsites.
Results |
At least 1 colonoscopy during 10 years before baseline was estimated to provide a 51% reduced hazard of CCD (hazard ratio [HR] 0.49; 95% confidence interval [CI], 0.45-0.54) over the following 8 years. When colonoscopy was modeled as a time-dependent covariate, the risk of CCD was further diminished (multivariable-adjusted HR 0.36; 95% CI, 0.33-0.38). Stratified analyses suggested moderately attenuated CCD risk reduction among the oldest age group; however, consideration of OCDs suggest that this is related to competing risks. CCD risk reduction related to colonoscopy was lower for proximal cancers.
Conclusions |
Colonoscopy within the previous 10 years provides substantial protective benefit for average-risk individuals over 60 years. CCD risk reduction may be maintained well beyond 74 years, a common upper age limit recommended by screening guidelines.
Le texte complet de cet article est disponible en PDF.Abbreviations : CCD, CIHI, CRC, DAD, HR, OCD, OCR, OHIP, SDS
Plan
| DISCLOSURE: This study was funded by a Cancer Care Ontario (CCO) SCREEN-NET Ontario grant, held by L.F. Paszat. Parts of this material are based on data and information provided by CCO. The opinions, results, view, and conclusions reported in this article are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred. This study was additionally supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (OMHLTC). The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario OMHLTC is intended or should be inferred. All authors disclosed no financial relationships relevant to this publication. |
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| See CME section; p. 142. |
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| If you would like to chat with an author of this publication, you may contact Dr Rabeneck at [email protected]. |
Vol 84 - N° 1
P. 133-141 - juillet 2016 Retour au numéro
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