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  • POPULATION  (26)
  • 1
    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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  • 2
    Keywords: POPULATION ; RISK-FACTORS ; score ; COLORECTAL-CANCER ; COMPLICATIONS ; RANDOMIZED CONTROLLED-TRIAL ; POLYPECTOMY ; sigmoidoscopy ; THERAPEUTIC COLONOSCOPY ; PERFORATION
    Abstract: BACKGROUND: The incidence of adverse events (AEs) is a crucial factor when colonoscopy is considered for mass screening, but few studies have addressed delayed and non-GI AEs. OBJECTIVES: To investigate the risk of AEs requiring hospitalization after screening and nonscreening colonoscopies compared with control subjects who did not undergo colonoscopy. DESIGN: Retrospective matched cohort. SETTING: Statutory health insurance fund in Germany. PATIENTS: A total of 33,086 individuals who underwent colonoscopy as an outpatient (8658 screening, 24,428 nonscreening) and 33,086 matched controls who did not undergo colonoscopy. INTERVENTIONS: Outpatient screening and nonscreening colonoscopies. MAIN OUTCOMES MEASUREMENTS: Risk of AEs (perforation, bleeding, myocardial infarction, stroke, splenic injury, and others) requiring hospitalization within 30 days after colonoscopy/index date and risk differences between the group that underwent colonoscopy and the group that did not. RESULTS: The incidence of perforation was 0.8 (95% confidence interval [CI], 0.3-1.7) and 0.7 (95% CI, 0.4-1.1) per 1000 screening and nonscreening colonoscopies, respectively. Hospitalizations because of bleeding occurred in 0.5 (95% CI, 0.1-1.2) and 1.1 (95% CI, 0.8-1.7) per 1000 screening and nonscreening colonoscopies, respectively. The incidence of myocardial infarction, stroke, and other non-GI AEs was similar in colonoscopy and control groups. No splenic injury was observed. Those with AEs generally had a higher mean age and comorbidity rate than the overall study population. LIMITATIONS: The analysis relies on health insurance claims data. CONCLUSIONS: This study provides further evidence of the safety of colonoscopy in routine practice with regard to delayed and non-GI AEs. Hospitalizations because of the investigated AEs were uncommon or rare for both screening and nonscreening colonoscopies.
    Type of Publication: Journal article published
    PubMed ID: 23410698
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  • 3
    Keywords: EXPRESSION ; POPULATION ; RISK ; GENOTYPES ; METAANALYSIS ; GENE POLYMORPHISMS ; VDR
    Abstract: Background: The vitamin D receptor (VDR) gene is present in colorectal cancer (CRC) cells and its genetic variants have been associated with an increased risk of CRC. The association with colorectal cancer prognosis remains widely unexplored. Methods: 1397 colorectal cancer patients participating in two cancer cohorts (ESTHER II and VERDI) and in a population-based case-control study (DACHS) were followed for 5 years. Unadjusted and adjusted hazard ratios for all-cause mortality (469 events) and CRC-specific mortality (336 events) were estimated for VDR variants rs731236 (TaqI), rs2228570 (FokI), rs11568820 (Cdx2), and rs1989969 (VDR-5132). Results: No association was found between VDR polymorphism and CRC specific and all-cause mortality. Adjusted hazard ratios ranged from 0.79 (95% CI 0.57-1.12) to 1.14 (95% CI 0.89-1.46) for CRC-specific mortality and from 0.89 (95% CI 0.67-1.18) to 1.22 (95% CI 0.99-1.50) for all-cause mortality. All 95% confidence intervals included the null value. Conclusions: Our findings do not support the hypothesis that the common VDR gene variants investigated in this study are of clinical relevance with respect to CRC prognosis.
    Type of Publication: Journal article published
    PubMed ID: 24075799
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  • 4
    Keywords: FOLLOW-UP ; POPULATION ; COLORECTAL-CANCER ; sensitivity ; EUROPE ; PROGRAM ; colonoscopy ; METAANALYSIS ; AVERAGE-RISK ; IMMUNOCHEMICAL TESTS
    Abstract: OBJECTIVES: Randomized trials have shown that annual or biannual screening by guaiac-based fecal occult blood tests (gFOBTs) reduces colorectal cancer (CRC) mortality. Few clinical studies have evaluated diagnostic performance of gFOBT through validation by colonoscopy in all participants. We aimed for a comprehensive evaluation of diagnostic performance of gFOBT by age and sex under routine screening conditions. METHODS: Our analysis is based on 20,884 colonoscopies following up a positive gFOBT and 182,956 primary screening colonoscopies documented in a state-wide quality assurance program in Bavaria, Germany, in 2007-2009. Positive likelihood ratios (LR+), which represent an integrative measure of diagnostic performance, were derived, by age groups (55-59, 60-64, 65-69, 70-74 years) and sex, from a joint and comparative analysis of prevalences of colorectal neoplasms in both groups. RESULTS: Overall LR+ (95% confidence intervals) were 1.11 (1.06-1.15), 1.80 (1.72-1.88), and 5.04 (4.64-5.47) for non-advanced adenoma, advanced adenoma, and cancer, respectively. Assuming a specificity of gFOBT of 95.2%, as recently observed in a German study among 2,235 participants of screening colonoscopy, these LR+ would translate to sensitivities of 5.3%, 8.6%, and 24.2% for the three outcomes, respectively. Diagnostic performance was similarly poor among women and men and across age groups. CONCLUSIONS: The performance of gFOBT under routine screening conditions is even worse than previously estimated from clinical studies. In routine screening application, gFOBTs are expected to miss more than 9 out of 10 advanced adenomas and 3 out of 4 cancers. These results underline the need and the potential for better noninvasive CRC screening tests.
    Type of Publication: Journal article published
    PubMed ID: 24343548
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  • 5
    Keywords: POPULATION ; RISK ; ADENOMAS ; COST-EFFECTIVENESS ; PARTICIPANTS ; RANDOMIZED CONTROLLED-TRIAL ; sigmoidoscopy ; OCCULT BLOOD-TESTS ; colonography ; NEGATIVE COLONOSCOPY
    Abstract: BACKGROUND: Colorectal cancer (CRC) is the second most common cancer among both men and women in Germany. Owing to its relatively slow growth, perspectives for effective early detection are much better than for other forms of cancer. AIM: To summarize the evidence on effectiveness and cost-effectiveness of CRC screening, and to provide an overview on the current state and perspectives for effective CRC screening. MATERIALS AND METHODS: Summary and critical review of evidence from randomized trials and observational epidemiological studies. RESULTS: A reduction in CRC mortality by offering annual fecal occult blood tests or once-only flexible sigmoidoscopy has been demonstrated in randomized trials. Novel fecal immunochemical tests for hemoglobin in stool have been shown to be more sensitive than traditional fecal occult blood tests and could substantially improve noninvasive CRC screening. Epidemiological studies suggest that the majority of CRC cases and deaths could be prevented by colonoscopy and removal of colorectal adenomas. However, adherence to screening offered outside organized screening programs is low. The National Cancer Plan recommends an organized CRC screening program in Germany. The law on the early detection of cancer from April 2013 has paved the way for its implementation. DISCUSSION: The great potential for CRC prevention by early detection has so far only been realized to a very limited extent in Germany. Introduction of an organized screening program and the offer of enhanced noninvasive screening tests could strongly enhance the utilization and effectiveness of CRC screening in Germany. The political frame has been set, and timely quality-assured implementation is required.
    Type of Publication: Journal article published
    PubMed ID: 24562704
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  • 6
    Keywords: CANCER ; POPULATION ; QUALITY ; sensitivity ; DIAGNOSTIC PERFORMANCE ; AVERAGE-RISK ; SCREENING COLONOSCOPY ; sex ; IMMUNOCHEMICAL TESTS ; SIDED COLORECTAL NEOPLASIA
    Abstract: Guaiac-based fecal occult blood tests (gFOBTs) are the most widely used noninvasive tests for colorectal cancer screening. While it is well known that they detect only a minority of colorectal adenomas, evidence for the characteristics of adenomas associated with detection is sparse. We derived estimates of the positive likelihood ratio (LR+), a summary measure of diagnostic performance, according to adenoma characteristics by comparing findings at colonoscopy among 19,208 and 181,128 participants who underwent colonoscopy to follow-up a positive gFOBT and as a primary screening examination, respectively, in Bavaria, Germany, in 2007-2009. Age and sex-adjusted estimates of LR+ (95% confidence intervals, 95% CI) ranged from 1.09 (1.05-1.13) for adenomas 〈1 cm to 2.52 (2.30-2.75) for adenomas 〉2 cm, and were much higher for pedunculated adenomas (1.96, 95% CI 1.85-2.08) than for flat or sessile adenomas (1.11, 95% CI 1.02-1.21 and 1.12, 95% CI 1.08-1.16, respectively). Villous or tubulovillous structure and dysplasia were likewise associated with a higher chance to be detected by gFOBT. Diagnostic performance was worse for proximal than for distal adenomas (age and sex adjusted LR+:1.16, 95% CI 1.09-1.23 and 1.35, 95% CI 1.29-1.41, respectively) which was explained by the lower proportions of large, pedunculated and nontubular adenomas in the proximal colon. Size, pedunculated shape, and nontubular histology are the key determinants of detection which also explain lower detection rates of adenomas located in the proximal colon.
    Type of Publication: Journal article published
    PubMed ID: 25142576
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  • 7
    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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  • 8
    Keywords: CANCER ; COMBINATION ; Germany ; COHORT ; cohort study ; DISEASE ; POPULATION ; RISK ; DRUG ; IMPACT ; REDUCTION ; ASSOCIATION ; TRIAL ; TRIALS ; ADENOMAS ; prevention ; HEALTH ; colorectal cancer ; PROSPECTIVE COHORT ; COLORECTAL-CANCER ; COLON-CANCER ; POPULATIONS ; case-control studies ; aspirin ; NONSTEROIDAL ANTIINFLAMMATORY DRUGS ; chemoprevention ; RANDOMIZED-TRIAL ; SINGLE ; ONCOLOGY ; case control study ; case-control study ; REGRESSION ; RE ; CARDIOVASCULAR-DISEASE ; METAANALYSIS ; case control studies ; INTERVAL ; USA ; prospective ; DRUGS ; odds ratio ; colorectal ; cardiovascular disease ; LONG-TERM USE ; LOGISTIC-REGRESSION ; statins
    Abstract: Recent research has drawn attention to protective effects of statins on colorectal cancer (CRC) and possible joint effects with other drugs. Because statins are often administered in combination With low-dose aspirin for the prevention of cardiovascular disease, the aim of our study was to investigate individual and combined effects of statins and low-dose aspirin on CRC risk. We assessed use of statins and low-dose aspirin in 540 cases with histologically confirmed incident CRC and 614 control subjects in a populations based case-control study in Germany. Multiple logistic regression. was used to estimate the impact of regular use of either low-dose aspirin or statins, and of both drugs combined on CRC risk. We found modest risk reduction of CRC for regular use of low-dose aspirin (adjusted odds ratio 0.77, 95% confidence interval 0.551.07) and a stronger association with regular use of statins (OR 0.65, 95% CI 0.43-0.99) or use of both drugs (OR 0.63, 95% CI 0.36-1.10). Combined use of low-dose aspirin and statins was associated with risk reduction by 62% after 5 or more years (OR 0.38, 95% CI 0.15-0.97). Combinational chemoprevention with low-dose aspirin and statins might provide stronger risk reduction than either of the single drugs after at least 5 years use, but confirmation is needed, preferably in prospective cohort studies and eventually by randomized controlled trials. (c) 2007 Wiley-Liss, Inc
    Type of Publication: Journal article published
    PubMed ID: 17487832
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  • 9
    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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  • 10
    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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