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  • SCREENING COLONOSCOPY  (3)
  • 1
    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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  • 2
    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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  • 3
    Keywords: REDUCTION ; NEOPLASIA ; prevention ; SURVEILLANCE ; POLYPS ; SCREENING COLONOSCOPY ; POPULATION-BASED ANALYSIS ; VIENNA CLASSIFICATION ; MISS RATES
    Abstract: BACKGROUND & AIMS: Screening colonoscopy is an effective method to reduce the incidence of and mortality from colorectal cancer (CRC). There is little empirical evidence available about the optimal interval for screening, making this a subject of debate. We associated the prevalence of advanced colorectal neoplasms with time since negative colonoscopies. METHODS: In a study of participants in the German colonoscopy screening program, we determined the prevalence of colorectal neoplasias detected at screening colonoscopy among subjects who had undergone a previous colonoscopy without detection of polyps (negative colonoscopy). Data were compared with that from subjects who had not received colonoscopies. RESULTS: No CRCs were detected in participants who had a previous negative colonoscopy an average of 11.9 years previously (n = 553), compared with the 8.4 CRC cases expected based on age- and gender-specific prevalences among participants who had not received a colonoscopy (n = 2701; standardized prevalence ratio [SPR] = 0.00; 95% confidence interval [CI]: 0.00-0.55). Prevalence of advanced adenoma was also much lower among subjects who had previous colonoscopies (SPR = 0.42; 95% CI: 0.25-0.68). Adjusted prevalence ratios (95% CIs) for detecting an advanced adenoma were 0.38 (95% CI: 0.16-0.90), 0.34 (95% CI: 0.15-0.74), 0.38 (95% CI: 0.16-0.90), and 0.53 (95% CI: 0.27-1.04) among participants with a negative colonoscopy conducted 1-5, 6-10, 11-15, and 〉16 years ago, respectively, compared to participants with no previous colonoscopy. CONCLUSIONS: The low risk of CRC and advanced adenomas after a negative colonoscopy supports suggestions that screening intervals be extended to 〉/=10 years.
    Type of Publication: Journal article published
    PubMed ID: 19909750
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