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

详细信息    查看全文

• 作者：David Stock ; PhD¹ ; Lawrence F. Paszat ; MD ; MS¹ ; ² ; ⁴ ; ⁵ ; ⁶ ; Linda Rabeneck ; MD ; MPH² ; ³ ; ⁵ ; ⁶ ;
• 关键词：CCD ; colorectal cancer death ; CIHI ; Canadian Institute for Health Information ; CRC ; colorectal cancer ; DAD ; discharge abstract database ; HR ; hazard ratio ; OCD ; other causes of death ; OCR ; Ontario Cancer Registry ; OHIP ; Ontario Health Insurance Plan ; SDS ; Same Day Surgery database
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：84
• 期：1
• 页码：133-141
• 全文大小：502 K

文摘

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.