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  • 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: RISK ; PERFORMANCE ; SURVEILLANCE ; MULTICENTER ; ENDOSCOPY ; POLYPECTOMY ; QUALITY INDICATORS ; COLORECTAL-CANCER INCIDENCE ; SOCIETY TASK-FORCE ; TANDEM COLONOSCOPY
    Abstract: BACKGROUND & AIMS: The adenoma detection rate (ADR) is an important quality indicator of screening colonoscopy; it is inversely associated with risk of interval cancers and colorectal cancer mortality. We assessed trends in the ADR in the first 10 years of the German screening colonoscopy program. METHODS: We calculated age-adjusted and age-specific detection rates of nonadvanced adenomas and advanced adenomas for each calendar year based on 4.4 million screening colonoscopies conducted from 2003 through 2012 and reported to the German screening colonoscopy registry. RESULTS: We observed a steady and strong increase in rate of detection of nonadvanced adenomas in both sexes and all age groups. Age-adjusted rates of detection of nonadvanced adenomas increased from 13.3% to 22.3% among men and from 8.4% to 14.9% among women. This increase was mostly due to an increase in detection rates of adenomas 〈0.5 cm, and it is partly explained by an innovation effect (higher ADRs among incoming colonoscopists than among leaving colonoscopists, and relatively stable ADRs among continuing colonoscopists). Only modest increases were observed in detection rates of advanced adenomas (from 7.4% to 9.0% among men, and from 4.4% to 5.2% among women) and colorectal cancer. In 2012, overall ADR reached 31.3% and 20.1% in men and women, respectively. CONCLUSIONS: We observed a strong increase in ADRs from 2003 through 2012 in Germany. Although we cannot exclude the effects of secular trends in colorectal neoplasm prevalence, the observed increase was mainly the result of a steady increase in detection of nonadvanced adenomas (especially adenomas 〈0.5 cm). Further research should address potential implications for defining screening and surveillance intervals.
    Type of Publication: Journal article published
    PubMed ID: 25911510
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  • 3
    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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  • 4
    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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  • 5
    Keywords: RISK ; prevention ; SURVEILLANCE ; PREVALENCE ; CANCER INCIDENCE ; ENDOSCOPY ; POLYPECTOMY ; sigmoidoscopy ; SCREENING COLONOSCOPY ; MISS RATE
    Abstract: Background Colonoscopy is used for early detection and prevention of colorectal cancer, but evidence on the magnitude of overall protection and protection according to anatomical site through colonoscopy performed in the community setting is sparse. We assessed whether receiving a colonoscopy in the preceding 10-year period, compared with no colonoscopy, was associated with prevalence of advanced colorectal neoplasms (defined as cancers or advanced adenomas) at various anatomical sites. Methods A statewide cross-sectional study was conducted among 3287 participants in screening colonoscopy between May 1, 2005, and December 31, 2007, from the state of Saarland in Germany who were aged 55 years or older. Prevalence of advanced colorectal neoplasms was ascertained by screening colonoscopy and histopathologic examination of any polyps excised. Previous colonoscopy history was obtained by standardized questionnaire, and its association with prevalence of advanced colorectal neoplasms was estimated, after adjustment for potential confounding factors by log-binomial regression. Results Advanced colorectal neoplasms were detected in 308 (11.4%) of the 2701 participants with no previous colonoscopy compared with 36 (6.1%) of the 586 participants who had undergone colonoscopy within the preceding 10 years. After adjustment, overall and site-specific adjusted prevalence ratios for previous colonoscopy in the previous 10-year period were as follows: overall, 0.52 (95% confidence interval [CI] = 0.37 to 0.73); cecum and ascending colon, 0.99 (95% CI = 0.50 to 1.97); hepatic flexure and transverse colon, 1.21 (95% CI = 0.60 to 2.42); right-sided colon combined (cecum to transverse colon), 1.05 (95% CI = 0.63 to 1.76); splenic flexure and descending colon, 0.36 (95% CI = 0.16 to 0.82); sigmoid colon, 0.29 (95% CI = 0.16 to 0.53); rectum, 0.07 (95% CI = 0.02 to 0.40); left colon and rectum combined (splenic flexure to rectum, referred to as left-sided elsewhere), 0.33 (95% CI = 0.21 to 0.53). Conclusion Prevalence of left-sided advanced colorectal neoplasms, but not right-sided advanced neoplasms, was strongly reduced within a 10-year period after colonoscopy, even in the community setting.
    Type of Publication: Journal article published
    PubMed ID: 20042716
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  • 6
    Keywords: CANCER ; DIAGNOSIS ; POPULATION ; RISK ; COST-EFFECTIVENESS ; COLON-CANCER ; UNITED-STATES ; sensitivity ; colorectal neoplasms ; SERVICES TASK-FORCE ; colonography ; OCCULT BLOOD-TEST ; ADVANCED ADENOMAS ; natural history
    Abstract: The sojourn time of preclinical colorectal cancer is a critical parameter in modeling effectiveness and cost-effectiveness of colorectal cancer screening. For ethical reasons, it cannot be observed directly, and available estimates are based mostly on relatively small historic data sets that do not include differentiation by age and sex. The authors derived sex- and age-specific estimates (age groups: 55-59, 60-64, 65-69, 70-74, 75-79, and more or equal 80 years) of mean sojourn time, combining data from the German national screening colonoscopy registry (based on 1.88 million records) and data from population-based cancer registries (population base: 37.9 million people) for the years 2003-2006. Estimates of mean sojourn time were similar for both sexes and all age groups and ranged from 4.5 years (95% confidence interval: 4.1, 4.8) to 5.8 years (95% confidence interval: 5.3, 6.3) for the subgroups assessed. Sensitivity analyses indicated that mean sojourn time might be approximately 1.5 years longer if colorectal cancer prevalence in nonparticipants of screening colonoscopy is 20% lower than prevalence in participants or 1 year shorter if it exceeds the prevalence in participants by 20%. This study provides, for the first time, precise estimates of sojourn time by age and sex, and it suggests that sojourn times are remarkably consistent across age groups and in both sexes.
    Type of Publication: Journal article published
    PubMed ID: 21984657
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  • 7
    Keywords: CANCER ; Germany ; screening ; incidence ; POPULATION ; RISK ; PATIENT ; colon ; ADENOMAS ; PROGRESSION ; DESIGN ; AGE ; WOMEN ; colorectal cancer ; MEN ; COLORECTAL-CANCER ; COST-EFFECTIVENESS ; RATES ; LINE ; EVOLUTION ; MALIGNANT TRANSFORMATION ; NATIONWIDE ; CARRIERS ; INDIVIDUALS ; SERIES ; PREVALENCE ; REGISTRY ; RE ; INCREASE ; TRANSITION ; colonoscopy ; CANCER INCIDENCE ; GUT ; REGISTRIES ; colorectal ; - ; GRADIENT ; LARGE-INTESTINE ; POLYPS ; SCREENING COLONOSCOPY ; adenoma ; YOUNGER
    Abstract: Objectives: To derive age and sex specific estimates of transition rates from advanced adenomas to colorectal cancer by combining data of a nationwide screening colonoscopy registry and national data on colorectal cancer ( CRC) incidence. Design: Registry based study. Setting: National screening colonoscopy programme in Germany. Patients: Participants of screening colonoscopy in 2003 and 2004 ( n = 840 149). Main outcome measures: Advanced adenoma prevalence, colorectal cancer incidence, annual and 10 year cumulative risk of developing CRC among carriers of advanced adenomas according to sex and age ( range 55 - 80+ years). Results: The age gradient is much stronger for CRC incidence than for advanced adenoma prevalence. As a result, projected annual transition rates from advanced adenomas to CRC strongly increase with age ( from 2.6% in age group 55 - 59 years to 5.6% in age group 〉= 80 years among women, and from 2.6% in age group 55 - 59 years to 5.1% in age group 〉= 80 years among men). Projections of 10 year cumulative risk increase from 25.4% at age 55 years to 42.9% at age 80 years in women, and from 25.2% at age 55 years to 39.7% at age 80 years in men. Conclusions: Advanced adenoma transition rates are similar in both sexes, but there is a strong age gradient for both sexes. Our estimates of transition rates in older age groups are in line with previous estimates derived from small case series in the pre-colonoscopy era independent of age. However, our projections for younger age groups are considerably lower. These findings may have important implications for the design of CRC screening programmes
    Type of Publication: Journal article published
    PubMed ID: 17591622
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  • 8
    Keywords: CANCER ; MODEL ; neoplasms ; POPULATION ; RISK ; STAGE ; prevention ; AGE ; colorectal cancer ; COLORECTAL-CANCER ; adenoma ; sex ; cost-saving analysis
    Abstract: Background: Screening colonoscopy has been offered in Germany since the end of 2002. Our aim was to estimate numbers of colorectal cancers prevented or detected early by screening colonoscopy in 2003-2010. Methods: Participation rates and prevalences of advanced adenomas and colorectal cancers at screening colonoscopy in 2003-2008 were obtained from the national screening colonoscopy database by age, sex and calendar year. For 2009 and 2010, levels were assumed to remain at those observed in 2008. These data were combined in Markov models with population figures and estimates of transition rates from advanced adenomas to preclinical colorectal cancer and from preclinical cancer to clinically manifest cancer, accounting for total mortality. Results: An estimated total number of 98 734 cases of colorectal cancer at ages 55-84 years are expected to have been prevented in Germany by removal of advanced adenomas by the end of 2010. These cancers might have become clinically manifest a median time period of 10 years after screening colonoscopy. Another 47 168 cases are expected to have been detected early at screening colonoscopy, often in a curable stage. Conclusion: Despite limited participation, the German screening colonoscopy program makes a major contribution to prevention and early detection of colorectal cancer
    Type of Publication: Journal article published
    PubMed ID: 21085544
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  • 9
    Keywords: CANCER ; tumor ; screening ; POPULATION ; RISK ; early detection ; AGE ; colon cancer ; TESTS ; ASYMPTOMATIC ADULTS ; sigmoidoscopy ; CRC ; OUTPATIENT COLONOSCOPY ; FECAL OCCULT BLOOD ; HEMOCCULT ; PROXIMAL NEOPLASMS
    Abstract: BACKGROUND & AIMS: Screening colonoscopy examinations for colorectal cancer are offered in the United States and some European countries. Data on results and adverse effects of screening colonoscopy are limited. In autumn 2002, colonoscopy was introduced as part of a nationwide cancer screening program in Germany; it was offered to the general population for individuals 55 years of age or older. We collected and analyzed data from this program. METHODS: We performed a prospective cross-sectional study, collecting results from 2,821,392 screening colonoscopies performed at more than 2100 practices by highly qualified endoscopists in Germany from January 2003 to December 2008. Data on participation, colorectal adenoma and cancer detection, and complications were collected using standardized documentation forms. The data generated were centrally processed and evaluated. RESULTS: The cumulative participation rate was 17.2% of eligible women and 15.5% of eligible men 55-74 years old. The adenoma detection rate (ADR) was 19.4%, with a higher rate in men (25.8% vs 16.7% in women). Advanced adenomas were found in 6.4% of patients. Carcinomas were detected in 25,893 subjects (0.9%); most were of an early UICC stage (I, 47.3%; II, 22.3%; III, 20.7%; IV, 9.6%). The ADRs for gastroenterologists and nongastroenterologists were 25.1% and 22.3%, respectively (adjusted odds ratio, 1.18; 95% confidence interval, 1.16-1.21). The overall complication rate was 2.8/1000 colonoscopies, and the rate of serious complications was 0.58/1000 colonoscopies. CONCLUSIONS: A nationwide colonoscopy screening program that uses highly qualified endoscopists can detect a significant number of adenomas and early-stage carcinomas. The ADR for gastroenterologists was higher than for nongastroenterologists
    Type of Publication: Journal article published
    PubMed ID: 22446606
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