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  • 1
    Keywords: CANCER ; Germany ; DIAGNOSIS ; FOLLOW-UP ; HISTORY ; RISK ; REDUCTION ; colon ; cancer prevention ; prevention ; HEALTH ; AGE ; WOMEN ; colorectal cancer ; MEN ; COLORECTAL-CANCER ; COST-EFFECTIVENESS ; RANDOMIZED-TRIAL ; ONCOLOGY ; RE ; INCREASE ; LEVEL ; biomarker ; case control studies ; cancer research ; ENDOSCOPY ; FLEXIBLE SIGMOIDOSCOPY ; colorectal ; ASYMPTOMATIC ADULTS ; LINE FINDINGS ; POLYPECTOMY ; SCREENING TRIAL
    Abstract: We aimed to estimate the proportions of colorectal cancer cases that might be prevented by sigmoidoscopy compared with colonoscopy among women and men. In a population-based case control study conducted in Germany, 540 cases with a first diagnosis of primary colorectal cancer and 614 controls matched for age, sex, and county of residence were recruited. A detailed lifetime history of endoscopic examinations of the large bowel was obtained by standardized personal interviews, validated by medical records, and compared between cases and controls, paying particular attention to location of colorectal cancer and sex differences. Overall, 39%, 77%, and 64% of proximal, distal, and total colorectal cancer cases were estimated to be preventable by colonoscopy. The estimated proportion of total colorectal cancer cases preventable by sigmoidoscopy was 45% among both women and men, assuming that sigmoidoscopy reaches the junction of the descending and sigmoid colon only and findings of distal polyps are not followed by colonoscopy. Assuming that sigmoidoscopy reaches the splenic flexure and colonoscopy is done after detection of distal polyps, estimated proportions of total colorectal cancer preventable by sigmoidoscopy increase to 50% and 55% (73% and 91% of total colorectal cancer preventable by primary colonoscopy) among women and men, respectively. We conclude that colonoscopy provides strong protection against colorectal cancer among both women and men. The proportion of this protection achieved by sigmoidoscopy with follow-up colonoscopy in case of distal polyps may be larger than anticipated. Among men, this regimen may be almost as effective as colonoscopy, at least at previous performance levels of colonoscopy
    Type of Publication: Journal article published
    PubMed ID: 17337649
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  • 2
    Keywords: CANCER ; Germany ; INFORMATION ; EXPOSURE ; RISK ; GENE ; METABOLISM ; PATIENT ; HETEROCYCLIC AMINES ; ASSOCIATION ; polymorphism ; SUSCEPTIBILITY ; AGE ; CIGARETTE-SMOKING ; colorectal cancer ; smoking ; COLORECTAL-CANCER ; cancer risk ; genetic polymorphism ; CARCINOGENS ; case-control studies ; TOBACCO ; INDIVIDUALS ; CONSUMPTION ; meat ; ONCOLOGY ; case-control study ; REGRESSION ; RE ; ALLELE ; CARCINOGEN ; SUBSTRATE ; case control studies ; INTERVAL ; ENZYME ; analysis ; GENOTYPE ; MEAT CONSUMPTION ; USA ; odds ratio ; RISK-FACTOR ; CANCER-RISK ; colorectal ; LOGISTIC-REGRESSION ; N-ACETYLTRANSFERASE-1 ; NAT2 GENETIC POLYMORPHISMS ; SULFOTRANSFERASE 1A1 ; SULT1A1
    Abstract: Several procarcinogens that are present in cooked red meat and tobacco smoke are substrates for sulfotransferase 1A1 (SULT1A1). The association between environmental exposures and colorectal cancer risk may be modified by individual differences in the metabolism. Thus, we investigated the effect of a common polymorphism in the SULT1A1 gene associated with decreased enzyme activity on the susceptibility to colorectal cancer in a population-based case-control study. Patients (505) and 604 age- and sex-matched controls provided detailed risk factor information and were genotyped for SULT1A1 G638A using a fluorescence-based melting curve analysis method. Multivariate logistic regression analysis was used to estimate colorectal cancer risk associated with environmental exposures by SULT1A1 genotype. SULT1A1 genotype was not an independent risk factor for colorectal cancer. Risk of colorectal cancer associated with frequent consumption of red meat was significantly elevated among carriers of the SULT1A1*2 allele but not increased among subjects with the SULT1A1*1/*1 genotype (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.1-4.1 and OR 1.0, 95% CI 0.5-2.1, respectively). Colorectal cancer risk associated with 30+ pack-years of active smoking was higher among carriers of the SULT1A1*2 allele (OR 1.7, 95 % CI 1.0-3.2) than among individuals with the SULT1A1*1/*1 genotype (OR 1.1, 95% CI 0.6-2.1). Our results do not support a main effect of SULT1A1 genotype with regard to colorectal cancer but suggest that individuals with the low activity SULT1A1*2 allele may be at higher risk following carcinogen exposure than those with the SULT1A1*1/*1 genotype. (c) 2006 Wiley-Liss, Inc
    Type of Publication: Journal article published
    PubMed ID: 17013894
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  • 3
    Keywords: CANCER ; Germany ; screening ; EPIDEMIOLOGY ; incidence ; MORTALITY ; prevention ; AGE ; WOMEN ; colorectal cancer ; MEN ; COLORECTAL-CANCER ; COUNTRIES ; GUIDELINES ; ONCOLOGY ; RE ; aging ; LEVEL ; ENGLAND
    Abstract: We assessed incidence and mortality of colorectal cancer (CRC) at various ages among women and men in 38 European countries. The ages at which defined levels of incidence and mortality were reached varied between 9 and 17 years between countries. This variation requires consideration in the definition of screening guidelines
    Type of Publication: Journal article published
    PubMed ID: 18628760
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  • 4
    Keywords: CANCER ; Germany ; MODEL ; MODELS ; neoplasms ; INFORMATION ; screening ; COHORT ; POPULATION ; RISK ; DESIGN ; AGE ; WOMEN ; colorectal cancer ; MEN ; COLORECTAL-CANCER ; PREVALENCE ; REGRESSION ; PROGRAM ; aging ; colonoscopy ; METAANALYSIS ; BIRTH ; CANCER INCIDENCE ; colorectal neoplasms ; PARTICIPATION ; POLYPS ; COHORTS ; STRATIFICATION
    Abstract: BACKGROUND: Prevalence of advanced colorectal neoplasms increases with age and is higher among men than women. Cross-sectional analyses estimated that men reach an equivalent prevalence at a much younger age than women. However, cross-sectional estimates may be confounded by birth cohort effects. OBJECTIVE: To estimate age and cohort effects in advanced colorectal neoplasms and to adjust risk-advancement periods for men compared with women for birth cohort effects. DESIGN: Age-cohort analyses. SETTING: German screening colonoscopy program, 2003 to 2007. PARTICIPANTS: 2 185 153 participants aged 55 to 75 years. MEASUREMENTS: Sex- and age-specific prevalence of colorectal cancer (CRC) and advanced neoplasms (CRC or advanced adenoma) were plotted with and without stratification by birth cohort. Risk-advancement periods with 95% CI for men compared with women were estimated from log-binomial regression models with and without cross-sectional analysis adjustment for birth cohort effects. RESULTS: Overall, 17 196 participants (0.8%) had CRC and 152 429 (7.0%) had any advanced neoplasm. Age-specific prevalence was higher in men than in women and in later birth cohorts. The apparent modest increase in prevalence by age in cross-sectional analysis was much steeper after birth cohort effects were controlled for. In cross-sectional analysis, risk-advancement periods (95% CI) for men compared with women were 8.4 years (CI, 7.7 to 9.0 years) and 16.1 years (CI, 15.8 to 16.5 years) for CRC and any advanced neoplasm, respectively, and 3.4 years (CI, 2.6 to 4.3 years) and 6.9 years (CI, 6.4 to 7.4 years) after controlling for birth cohort effects. LIMITATION: Information on covariates that could explain cohort effects was lacking. CONCLUSION: In this population, strong cohort effects reduced age gradients in advanced colorectal neoplasms and inflated risk-advancement periods for men compared with women, but major risk advancement persisted, even after birth cohort effects were controlled for. Primary Funding Source: None.
    Type of Publication: Journal article published
    PubMed ID: 20513827
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  • 5
    Keywords: CANCER ; Germany ; screening ; TOOL ; HISTORY ; incidence ; MORTALITY ; POPULATION ; RISK ; RISKS ; TIME ; PATIENT ; REDUCTION ; colon ; prevention ; AGE ; colorectal cancer ; COLORECTAL-CANCER ; COST-EFFECTIVENESS ; case-control studies ; FEASIBILITY ; RELATIVE RISK ; RECTAL-CANCER ; case-control study ; RE ; INCREASE ; case control studies ; INTERVAL ; CANCER INCIDENCE ; odds ratio ; population-based ; AVERAGE-RISK ; ENDOSCOPY ; FLEXIBLE SIGMOIDOSCOPY ; SERVICES TASK-FORCE
    Abstract: Background and aims: Screening colonoscopy is thought to be a powerful and cost-effective tool to reduce colorectal cancer incidence and mortality. Whether and when colonoscopy with negative findings has to be repeated is not well defined. The aim of this study was to assess the long term risk of clinically manifest colorectal cancer among subjects with negative findings at colonoscopy. Patients: 380 cases and 485 controls participating in a population based case-control study in Germany. Methods: Detailed history and results of previous colonoscopies were obtained by interview and from medical records. Adjusted relative risks of colorectal cancer among subjects with a previous negative colonoscopy compared with those without previous colonoscopy were estimated according to time since colonoscopy. Results: Subjects with previous negative colonoscopy had a 74% lower risk of colorectal cancer than those without previous colonoscopy (adjusted odds ratio (aOR) = 0.26 (95% confidence interval, 0.16 to 0.40)). This low risk was seen even if the colonoscopy had been done up to 20 or more years previously. Particularly low risks were seen for sigma cancer (aOR = 0.13 (0.04 to 0.43)) and for rectal cancer (aOR = 0.19 (0.09 to 0.39)), and after a negative screening colonoscopy at ages 55 to 64 (aOR = 0.17 (0.08 to 0.39)) and older (aOR = 0.21 (0.10 to 0.41)). Conclusions: Subjects with negative findings at colonoscopy are at very low risk of colorectal cancer and might not need to undergo repeat colonoscopy for 20 years or more, if at all. The possibility of extending screening intervals to 20 years or more might reduce complications and increase the feasibility and cost-effectiveness of colonoscopy based screening programmes
    Type of Publication: Journal article published
    PubMed ID: 16469791
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  • 6
    Keywords: CANCER ; Germany ; RISK ; PATIENT ; ASSOCIATION ; polymorphism ; BREAST-CANCER ; AGE ; CIGARETTE-SMOKING ; smoking ; COLORECTAL-CANCER ; BLADDER-CANCER ; METABOLIC-ACTIVATION ; COLON-CANCER ; case-control studies ; TOBACCO ; INDIVIDUALS ; CONSUMPTION ; RECTAL-CANCER ; case-control study ; population-based case-control study ; RE ; case control studies ; INTERVAL ; RISK-FACTOR ; population-based ; PASSIVE SMOKING ; ARYLAMINE N-ACETYLTRANSFERASE ; INCREASES RISK ; RECOMBINANT HUMAN NAT1
    Abstract: N-Acetyltransferases 1 and 2 (NAT1 and NAT2), both being highly polymorphic, are involved in the metabolism of aromatic and heterocyclic aromatic amines present in cigarette smoke and red meat cooked by high-temperature cooking techniques. We investigated the effect of differences in acetylation capacity, determined by NAT1 and NAT2 genotypes, on colorectal cancer risk associated with exposure to tobacco smoke or red meat consumption. In this population-based case-control study in Germany, 505 patients with incident colorectal cancer and 604 age- and sex-matched control individuals with genotyping data and detailed risk factor information were included. Genotyping of NAT1 and NAT2 genetic polymorphisms was done using a fluorescence-based melting curve analysis method. The association between genotypes, environmental exposures, and colorectal cancer risk was estimated using multivariate logistic regression. Colorectal cancer risk associated with active smoking was elevated after accumulation of 30(+) pack-years of smoking [odds ratio (OR), 1.4; 95% confidence interval (95% CI), 0.9-2.2] but not significantly modified by either NAT1 or NAT2 genotype. Exposure to environmental tobacco smoke was associated with an increased risk for colorectal cancer only among NAT2 fast acetylators (OR, 2.6; 95% CI, 1.1-5.9 for exposure in childhood and adulthood). Frequent consumption of red meat significantly increased colorectal cancer risk for the group comprising all NAT2 fast acetylators or carriers of the NAT1*10 allele (OR, 2.6; 95% Cl, 1.1-6.1) but not among those with "slow" NAT1 and NAT2 genotypes. Our findings indicate that NAT1 and NAT2 genotypes may contribute jointly to individual susceptibility and that heterocyclic aromatic amines may play an important role in colorectal cancer associated with red meat and possibly also exposure to environmental tobacco smoke
    Type of Publication: Journal article published
    PubMed ID: 16434594
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  • 7
    Keywords: CANCER ; Germany ; HISTORY ; MORTALITY ; RISK ; validation ; FAMILY ; REDUCTION ; NO ; prevention ; HEALTH ; AGE ; family history ; colorectal cancer ; COLORECTAL-CANCER ; EFFICACY ; cancer risk ; case-control studies ; aspirin ; sensitivity ; specificity ; VALIDITY ; SCREENING SIGMOIDOSCOPY ; case control study ; case-control study ; RE ; FAMILIES ; colonoscopy ; case control studies ; INTERVAL ; FAMILY-HISTORY ; USA ; reproducibility of results ; odds ratio ; CANCER-RISK ; colorectal neoplasms ; ENDOSCOPY ; colorectal ; POLYPECTOMY ; KAPPA ; mass screening ; MEDICAL-RECORD AUDIT ; reporting ; validation studies ; VETERANS
    Abstract: Large-bowel endoscopy with removal of polyps strongly reduces colorectal cancer risk. In epidemiologic studies, ascertainment of large-bowel endoscopies often relies on self-reports and might be prone to imperfect recall. In 2003-2004, the authors assessed the validity of self-reported colorectal endoscopies in a population-based case-control study including 540 cases and 614 controls from southwest Germany and calculated odds ratios of colorectal cancer risk according to self-reports and medical records. They sought to obtain all medical records for the last self-reported endoscopy and for a subsample of 100 subjects reporting no previous endoscopy. In total, 377 of 483 records could be obtained (78%). Sensitivity of self-reports was 100%, and specificity ranged from 93% to 98% among subgroups defined by age, gender, education, family history of colorectal cancer, and case-control status. The odds ratios for colorectal cancer risk after previous colonoscopy were 0.31 (95% confidence interval: 0.21, 0.45) using self-reports and 0.31 (95% confidence interval: 0.20, 0.47) using medical records. However, agreement between self-reports and medical records was poor regarding type of endoscopy (colonoscopy, sigmoicloscopy, or rectoscopy; kappa = 0.22), moderate concerning polypectomy (kappa = 0.58), and reasonable for year of examination (kappa = 0.70). Self-reports of previous colorectal endoscopies agreed well with medical records, but validation appears to be essential with respect to details of the examination
    Type of Publication: Journal article published
    PubMed ID: 17456475
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  • 8
    Keywords: CANCER ; Germany ; screening ; HISTORY ; incidence ; POPULATION ; RISK ; PATIENT ; FAMILY ; HEALTH ; DIFFERENCE ; AGE ; family history ; WOMEN ; meta-analysis ; colorectal cancer ; MEN ; COLORECTAL-CANCER ; COLON-CANCER ; UNITED-STATES ; RELATIVES ; INITIATION ; RELATIVE RISK ; GUIDELINES ; STATES ; REGISTRY ; review ; RE ; AGGREGATION ; FAMILIES ; aging ; cancer registries ; colonoscopy ; METAANALYSIS ; LEVEL ; methods ; cancer registry ; FAMILY-HISTORY ; PEOPLE ; RECOMMENDATIONS ; population-based ; ENGLAND ; LARGE-BOWEL-CANCER ; GRADIENT ; STATE
    Abstract: OBJECTIVES: To review and combine the best available epidemiological evidence, by sex and age, that may help decision and policy makers form recommendations as to how much earlier colorectal cancer (CRC) screening should be initiated among people with a family history of CRC than among average-risk people. PATIENTS AND METHODS: Combining population-based cancer registry and health interview survey data from the United States and results of a recent meta-analysis of epidemiological studies, we estimated cumulative incidence of CRC within subsequent 10 yr (Cl-10) at various ages among men and women with and without a family history of CRC. We estimated both the Cl-10 levels reached in average-risk 45-, 50-, 55-, and 60-yr-old men and women and the age at which the same Cl-10 levels are reached in men and women with a history of CRC in a first-degree relative. RESULTS: Despite major differences in CRC risk by sex, and despite the strong age gradient in relative risk associated with a positive family history, "risk advancement periods" for those with a family history were consistently found to be between 9 and 11 yr for both sexes and at all four ages assessed. CONCLUSION: Advancement of first CRC screening by 10 yr among both men and women with a family history of CRC compared to the average-risk population (e.g., from 50 to 40 yr of age) appears to be a reasonable, evidence-based recommendation
    Type of Publication: Journal article published
    PubMed ID: 18702651
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  • 9
    Keywords: CANCER ; Germany ; screening ; TOOL ; POPULATION ; RISK ; IMPACT ; ADENOMAS ; prevention ; AGE ; WOMEN ; colorectal cancer ; MEN ; COLORECTAL-CANCER ; CERVICAL-CANCER ; RATES ; DATABASE ; EUROPE ; colonoscopy ; RANDOMIZED CONTROLLED-TRIAL ; colorectal ; POLYPECTOMY ; CRC ; REMOVAL
    Abstract: In late 2002, colonoscopy was introduced as a primary screening tool for colorectal cancer (CRC) in Germany We aimed to estimate the expected reduction in case numbers and incidence of CRC between 2003 and 2010 by detection and removal of advanced adenomas. Data from 1,875,708 women and men included in the national screening colonoscopy database were combined with estimates of transition rates of advanced adenomas and with national population projections. Despite relatively low screening participation, incident CRC cases are expected to be reduced by more than 15,000 between 2003 and 2010. The impact is expected to be largest in age groups 55-59, 60-64 and 65-69 in whom total case numbers in 2010 are expected to be reduced by 13%, 19% and 14% among women, and by 11%, 15% and 12%, respectively, among men. our results forecast a major rapid reduction of the CRC burden in Germany by screening colonoscopy. (c) 2009 Elsevier Ltd. All rights reserved
    Type of Publication: Journal article published
    PubMed ID: 19289271
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  • 10
    Keywords: CANCER ; carcinoma ; RISK ; PROTEIN ; POLYMORPHISMS ; AGE ; colonoscopy ; METAANALYSIS ; colorectal neoplasms ; Helicobacter pylori ; COLONIC ADENOMAS ; SEROPREVALENCE ; SEROPOSITIVITY ; ATROPHIC GASTRITIS ; ERADICATION ; HYPERGASTRINEMIA
    Abstract: Evidence concerning the role of Helicobacter pylori infection in the development of colorectal cancer remains controversial. The authors assessed the association of H. pylori seroprevalence with risk of colorectal cancer in a large population-based case-control study from Germany in 2003-2007. Serum antibodies to H. pylori in general and the cytotoxin-associated gene A protein (CagA) were measured in 1,712 incident colorectal cancer cases and 1,669 controls. The association between H. pylori seroprevalence and colorectal cancer risk was estimated by logistic regression, with adjustment for potential confounders and stratification by age group, sex, anatomic subsites, and cancer stage. Overall, H. pylori seroprevalence was higher in cases (46.1%) than in controls (40.1%), resulting in an age- and sex-adjusted odds ratio of 1.30 (95% confidence interval (CI): 1.14, 1.50). Adjustment for established colorectal cancer risk factors decreased the odds ratio to 1.26 (95% CI: 1.09, 1.47), with a further reduction to 1.18 (95% CI: 1.01, 1.38) after additional adjustment for previous colorectal endoscopy. Stratified analyses showed risk elevation to be essentially confined to left-sided colorectal cancer, with an odds ratio of 1.22 (95% CI: 1.02, 1.45), suggesting that H. pylori infection may be associated with a small yet relevant risk increase in the left colorectum.
    Type of Publication: Journal article published
    PubMed ID: 22294430
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