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  • MORTALITY  (15)
  • 1
    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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  • 2
    Keywords: PATHWAY ; THERAPY ; MORTALITY ; RISK ; prognosis ; PROSPECTIVE COHORT ; microsatellite instability ; colonoscopy ; DRUGS ; BETA-BLOCKER USE
    Abstract: Background: Statins have been associated with moderate reductions in mortality among colorectal cancer (CRC) patients, but these studies lacked adjustment for some potentially relevant factors associated with statin use. We aimed to provide more detailed results on this association from a population-based patient cohort study. Methods: Use of statins and other risk or protective factors were assessed in standardized interviews with 2697 patients from southern Germany with a diagnosis of incident CRC between 2003 and 2009 (Darmkrebs: Chancen der Verhutung durch Screening [DACHS] study). Follow-up included assessment of therapy details, recurrence, vital status, and cause of death. Information about molecular pathological subtypes of CRC was available for 1209 patients. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs). All statistical tests were two-sided. Results: Patients were age 68 years on average, 412 used statins (15%), and 769 died during follow-up (29%). After a median follow-up time of 3.4 years, use of statins was not associated with overall (HR = 1.10, 95% CI = 0.85 to 1.41), CRC-specific (HR = 1.11, 95% CI = 0.82 to 1.50), or recurrence-free survival (HR = 0.90, 95% CI = 0.63 to 1.27). Analyses in relevant subgroups also showed no association of statin use with overall and CRC-specific survival, and no associations were observed after stratifying for major pathological subtypes. Among stage I and II patients, statin use was associated with better recurrence-free but not with better CRC-specific survival. Conclusions: Statin use was not associated with reduced mortality among CRC patients. Effects reported in previous studies might reflect incomplete control for stage at diagnosis and other factors associated with the use of statins.
    Type of Publication: Journal article published
    PubMed ID: 25770147
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  • 3
    Keywords: MORTALITY ; SURGERY ; RISK-FACTORS ; HEALTH ; CIGARETTE-SMOKING ; COLON-CANCER ; LIFE-STYLE ; METAANALYSIS ; CHEMOTHERAPEUTIC DRUGS ; INHIBITS APOPTOSIS
    Abstract: Current evidence on the association between smoking and colorectal cancer (CRC) prognosis after diagnosis is heterogeneous and few have investigated dose-response effects or outcomes other than overall survival. Therefore, the association of smoking status and intensity with several prognostic outcomes was evaluated in a large population-based cohort of CRC patients; 3,130 patients with incident CRC, diagnosed between 2003 and 2010, were interviewed on sociodemographic factors, smoking behavior, medication and comorbidities. Tumor characteristics were collected from medical records. Vital status, recurrence and cause of death were documented for a median follow-up time of 4.9 years. Using Cox proportional hazards regression, associations between smoking characteristics and overall, CRC-specific, non-CRC related, recurrence-free and disease-free survival were evaluated. Among stage I-III patients, being a smoker at diagnosis and smoking 15 cigarettes/day were associated with lower recurrence-free (adjusted hazard ratios (aHR): 1.29; 95% confidence interval (CI): 0.93-1.79 and aHR: 1.31; 95%-CI: 0.92-1.87) and disease-free survival (aHR: 1.26; 95%-CI: 0.95-1.67 and aHR: 1.29; 95%-CI: 0.94-1.77). Smoking was associated with decreased survival in stage I-III smokers with pack years 20 (Overall survival: aHR: 1.40; 95%-CI: 1.01-1.95), in colon cancer cases (Overall survival: aHR: 1.51; 95%-CI: 1.05-2.17) and men (Recurrence-free survival: aHR: 1.51; 95%-CI: 1.09-2.10; disease-free survival: aHR: 1.49; 95%-CI: 1.12-1.97), whereas no associations were seen among women, stage IV or rectal cancer patients. The observed patterns support the existence of adverse effects of smoking on CRC prognosis among nonmetastatic CRC patients. The potential to enhance prognosis of CRC patients by promotion of smoking cessation, embedded in tertiary prevention programs warrants careful evaluation in future investigations. What's new? Smoking is an established risk factor for a variety of cancers, including colorectal cancer, but evidence regarding its impact on the prognosis of colorectal cancer patients remains sparse. In this population-based study of 3,130 colorectal cancer patients, smoking was associated with reduced survival among patients with nonmetastatic colon cancer. The analyses suggested that the association may be more pronounced in men than women. Future studies should take into account relationships between smoking and other lifestyle factors and should explore the potential role of using the teachable moment of cancer diagnosis in the promotion of smoking cessation.
    Type of Publication: Journal article published
    PubMed ID: 25758762
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  • 4
    Keywords: DIAGNOSIS ; MORTALITY ; RISK ; TRIAL ; DATABASE ; NATURAL-HISTORY ; PARTICIPANTS ; ENDOSCOPY ; sigmoidoscopy
    Abstract: Aim: Endoscopy based screening programmes for colorectal cancer (CRC) are being implemented in an increasing number of countries. In Germany, screening colonoscopy at age 55 or older has been offered since the end of 2002. We aimed to estimate the long-term impact of this offer on CRC prevention. Methods: We estimated numbers of prevented CRC cases by expected age and year of their (prevented) occurrence over four decades (2005-2045) by four state Markov models (non-advanced adenoma, advanced adenoma, preclinical CRC, clinically manifest CRC). Estimates are based on screening colonoscopies reported to the German screening colonoscopy registry in 2003-2012 (N = 4,407,971), transition rates between the four states and general population mortality rates. Results: Numbers of prevented clinically manifest CRC cases are projected to increase from 〈100 in 2005 to approximately 6500 in 2015, 12,600 in 2025, 15,400 in 2035 and 16,000 in 2045, compared to approximately 58,000 incident cases observed in 2003. The annual number of prevented cases is expected to be higher among men than among women and to strongly vary by age. The vast majority of prevented cases would have occurred at age 75 or older. Conclusions: Despite modest participation rates, the German screening colonoscopy programme will lead to substantial reductions in the CRC burden. The reductions will be fully disclosed in the long run only and predominantly affect numbers of incident cases above 75 years of age. Screening offers would need to start at younger ages in order to achieve more effective CRC prevention at younger ages.
    Type of Publication: Journal article published
    PubMed ID: 25908273
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  • 5
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    BMC Medicine 13 (), Art. Nr.: 262- 
    Keywords: FOLLOW-UP ; MORTALITY ; GUIDELINES ; PROGRAM ; colonoscopy ; PARTICIPANTS ; RANDOMIZED CONTROLLED-TRIAL ; sigmoidoscopy ; OCCULT BLOOD-TEST ; FECAL IMMUNOCHEMICAL TESTS
    Abstract: Background: Colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancer deaths globally. However, there is overwhelming evidence that a large proportion of CRC cases and deaths could be prevented by screening. Nevertheless, CRC screening programmes are offered in a minority of countries only and often suffer from low adherence. Discussion: Factors potentially accounting for hesitant implementation of and low adherence to CRC screening may include a lower attention in the public and the media than for other cancers and the fairly long follow-up time needed to fully disclose screening effects on CRC incidence and mortality. The latter results from the very slow development of most CRCs through the adenoma-carcinoma sequence, and it challenges the predominant or even exclusive reliance on evidence from randomized controlled trials in policy decisions on screening offers. Additional key elements of future research should include (1) studies evaluating diagnostic performance of novel biomarkers for non-invasive or minimally invasive CRC screening in true screening settings, (2) modelling studies evaluating expected short-and long-term impact, effectiveness, and cost-effectiveness of various screening options, and (3) timely and close monitoring of process quality and outcomes of existing and planned CRC screening programmes. Most importantly, however, translation of the vast existing evidence on CRC screening into actual screening programmes with the best possible levels of adherence needs to be fostered. This can be best achieved in the context of organized programmes. Depending on available infrastructure and resources, epidemiological patterns, population preferences, and costs, different screening offers might be preferred. According to current evidence, colonoscopy, flexible sigmoidoscopy, and faecal occult blood tests (preferably faecal immunochemical tests) are prime candidates for effective and cost-effective screening options, and microsimulation models should help to tailor their implementation. Summary: The strong evidence for the large potential of CRC screening in reducing the burden of CRC calls for timely implementation of organized screening programmes where they are not in place yet, and for continuous improvement of existing ones. This should be considered an obligation that is not to be postponed: the time to act is now.
    Type of Publication: Journal article published
    PubMed ID: 26459270
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  • 6
    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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  • 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 ; FOLLOW-UP ; MORTALITY ; POPULATION ; PERFORMANCE ; METAANALYSIS ; AVERAGE-RISK ; SCREENING COLONOSCOPY ; ADENOMA DETECTION ; IMMUNOCHEMICAL TESTS
    Abstract: Guaiac-based fecal occult blood tests (gFOBTs) are the most commonly applied tests for colorectal cancer screening globally but have relatively poor sensitivity to detect colorectal neoplasms. Men have higher prevalences of colorectal neoplasms than women. In case of a positive gFOBT result, participants are referred to colonoscopy, independent of sex. To assess performance of gFOBT in routine screening practice, we assessed age and sex specific prevalences (age groups: 55-59, 60-64, 65-69 and 70-74) of colorectal neoplasms in 182,956 women and men undergoing colonoscopy for primary screening and in 20,884 women and men undergoing colonoscopy to follow-up a positive gFOBT in Bavaria, Germany, in 2007-2009. We conducted model calculations to estimate prevalences among gFOBT negative individuals. Analogous model calculations were performed for women and men tested positive or negative with fecal immunochemical tests. In all age groups (55-59, 60-64, 65-69 and 70-74 years), men undergoing colonoscopy for primary screening had substantially higher prevalences of any colorectal neoplasms and essentially the same prevalences of advanced colorectal neoplasms compared to women undergoing colonoscopy to follow-up a positive gFOBT. Model calculations suggest that men with negative gFOBT likewise have substantially higher prevalences of colorectal neoplasms than gFOBT positive women in each age group. Model calculations further indicate that no such sex paradoxon occurs, and a much clearer risk stratification can be achieved with fecal immunochemical tests. Our findings underline need to move forward from and overcome shortcomings of gFOBT-based colorectal cancer screening.
    Type of Publication: Journal article published
    PubMed ID: 24374771
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  • 9
    Keywords: CANCER ; Germany ; screening ; EPIDEMIOLOGY ; MORTALITY ; POPULATION ; DIFFERENTIATION ; TIME ; NEOPLASIA ; prevention ; PATTERNS ; AGE ; WOMEN ; colorectal cancer ; MEN ; COLORECTAL-CANCER ; COUNTRIES ; US ; POPULATIONS ; UNITED-STATES ; INITIATION ; GUIDELINES ; ONCOLOGY ; RE ; ELDERLY-PATIENTS ; colonoscopy ; HORMONE-REPLACEMENT THERAPY ; LEVEL ; cancer registry ; EXTENT ; colorectal ; BENEFITS ; MILLION WOMEN ; sigmoidoscopy
    Abstract: There is some variation regarding age at initiation of screening for colorectal cancer (CRC) between countries, but the same age of initiation is generally recommended for women and men within countries, despite important gender differences in the epidemiology of CRC. We have explored whether, and to what extent, these differences would be relevant regarding age at initiation of CRC screening. Using population-based cancer registry data from the US and national mortality statistics from different countries, we looked at cumulative 10-year incidence and mortality of CRC reached among men at ages 50, 55, and 60, and found that women mainly reached equivalent levels when 4 to 8 years older. The gender differences were remarkably constant across populations and over time. These patterns suggest that gender differentiation of age at initiation may be worthwhile to utilise CRC-screening resources more efficiently
    Type of Publication: Journal article published
    PubMed ID: 17311019
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  • 10
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    Internist 49 (6), 655-659 
    Keywords: evaluation ; Germany ; DIAGNOSIS ; screening ; TOOL ; DISEASE ; DISEASES ; MORTALITY ; NEW-YORK ; early detection ; prevention ; NUMBER ; FECAL-OCCULT-BLOOD ; COLORECTAL-CANCER ; COMPLICATIONS ; MANAGEMENT ; IMPLEMENTATION ; colonoscopy ; PHASE ; OVERDIAGNOSIS ; USA ; COSTS ; MEDICINE ; evidence based medicine
    Abstract: Screening can be a very powerful tool for prevention or more effective treatment of diseases. However, a number of prerequisites have to be met. Only diseases with a preclinical phase, during which the disease or its precursors can be detected by a suited test, are amenable to screening. Early detection of the disease must enable either prevention or more effective management of the disease and not just prolong the "patient career". The benefits of screening must encompass potential harms, which may include, for example, complications, false positive diagnoses or over-diagnoses (i.e. the diagnosis of clinically irrelevant disease). Benefits from screening must be achieved at acceptable costs. Implementation of screening has to be based on scientific evidence and accompanied by scientific evaluation
    Type of Publication: Journal article published
    PubMed ID: 18392600
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