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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 ; 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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  • 3
    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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  • 4
    Keywords: CANCER ; Germany ; THERAPY ; RISK ; INDEX ; REDUCTION ; CONTRAST ; ASSOCIATION ; BREAST-CANCER ; hormone ; WOMEN ; colorectal cancer ; HORMONE REPLACEMENT THERAPY ; COLORECTAL-CANCER ; COLON-CANCER ; UNITED-STATES ; case-control studies ; BODY ; POSTMENOPAUSAL WOMEN ; menopause ; MASS INDEX ; MASSES ; BODIES ; ONCOLOGY ; case control study ; case-control study ; RE ; THERAPIES ; interaction ; colonoscopy ; METAANALYSIS ; case control studies ; INTERVAL ; MASS ; RANDOMIZED CONTROLLED-TRIAL ; OVERWEIGHT ; HORMONES ; ESTROGEN PLUS PROGESTIN ; REPLACEMENT THERAPY ; odds ratio ; population-based ; ENGLAND ; REPLACEMENT ; colorectal ; case control ; NOV ; postmenopausal ; BODY-MASS ; BODY-MASS-INDEX ; German ; case-control ; body mass
    Abstract: Previous studies have reported inconsistent results regarding the modifying effect of hormone replacement therapy (HRT) on the association of body mass index (BMI) and the risk of colorectal cancer (CRC) among postmenopausal women. We assessed the use of HRT and BMI in 208 postmenopausal women with histologically confirmed incident CRC and 246 controls in a population-based case-control study in Germany (DACHS study). Ever use of HRT was strongly associated with reduction of CRC risk (adjusted odds ratio 0.41, 95% confidence interval 0.25-0.67). Among nonusers of HRT, risk of CRC was strongly increased in women with BMI 27 to 〈 30 kg m(-2) (2.76, 1.07-7.12) and obese women (3.30, 1.25-8.72), when compared with women with BMI 〈 23 kg m(-2) (P for trend 〈 0.01). BMI was not associated with risk of CRC among HRT users (P for interaction 〈 0.01). In contrast to most other studies, a positive association of BMI and CRC risk was found among nonusers of HRT, but not among users of HRT. The reasons for the inconsistency of results regarding the potential risk modifying effect of postmenopausal hormones in the association of BMI with CRC remain inconclusive and require further study
    Type of Publication: Journal article published
    PubMed ID: 17987040
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  • 5
    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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  • 6
    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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  • 7
    Keywords: WOMEN ; CIGARETTE-SMOKING ; COLON-CANCER ; UNITED-STATES ; RECTAL-CANCER ; GENETIC EPIDEMIOLOGY ; BODY-SIZE ; susceptibility loci ; GENOME-WIDE ASSOCIATION ; INSTRUMENTAL VARIABLES
    Abstract: Background: For men and women, taller height is associated with increased risk of all cancers combined. For colorectal cancer (CRC), it is unclear whether the differential association of height by sex is real or is due to confounding or bias inherent in observational studies. We performed a Mendelian randomization study to examine the association between height and CRC risk. Methods: To minimize confounding and bias, we derived a weighted genetic risk score predicting height (using 696 genetic variants associated with height) in 10 226 CRC cases and 10 286 controls. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for associations between height, genetically predicted height and CRC. Results: Using conventional methods, increased height (per 10-cm increment) was associated with increased CRC risk (OR = 1.08, 95% CI = 1.02-1.15). In sex-specific analyses, height was associated with CRC risk for women (OR = 1.15, 95% CI = 1.05-1.26), but not men (OR = 0.98, 95% CI = 0.92-1.05). Consistent with these results, carrying greater numbers of (weighted) height-increasing alleles (per 1-unit increase) was associated with higher CRC risk for women and men combined (OR = 1.07, 95% CI = 1.01-1.14) and for women (OR = 1.09, 95% CI = 1.01-1.19). There was weaker evidence of an association for men (OR = 1.05, 95% CI = 0.96-1.15). Conclusion: We provide evidence for a causal association between height and CRC for women. The CRC-height association for men remains unclear and warrants further investigation in other large studies.
    Type of Publication: Journal article published
    PubMed ID: 25997436
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  • 8
    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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  • 9
    Keywords: CANCER ; COMBINATION ; Germany ; THERAPY ; COHORT ; RISK ; validation ; FAMILY ; REDUCTION ; BREAST-CANCER ; hormone ; AGE ; WOMEN ; colorectal cancer ; COLORECTAL-CANCER ; cancer risk ; COLON-CANCER ; case-control studies ; POSTMENOPAUSAL WOMEN ; case control study ; case-control study ; population-based case-control study ; FAMILIES ; THERAPIES ; METAANALYSIS ; ESTROGEN ; pharmacology ; USA ; REPLACEMENT THERAPY ; population-based ; CANCER-RISK ; REPLACEMENT ; colorectal ; ESTROGEN REPLACEMENT THERAPY ; hormone therapy ; HORMONE-THERAPY ; CONFIDENCE ; CRC ; LARGE-BOWEL CANCER ; PLUS PROGESTIN
    Abstract: Little is known about the effects of various types, modes, and routes of hormone replacement therapy (HRT) on the risk of colorectal cancer (CRC) among postmenopausal women. We conducted a population-based case-control study with validation of self-reported hormone use and no upper age limit. In 1,456 postmenopausal women aged 45-94 years (546 cases, 910 controls), the use of HRT was associated with reduction in CRC risk among ever users (adjusted odds ratio (OR) 0.65, 95% confidence interval 0.50-0.84), current users, and recent users. There was no evidence that risk reduction among current users varies by age. Risk reduction was seen both in estrogen-only therapy (0.42, 0.23-0.78) and in combination therapy (0.60, 0.41-0.87), the latter regardless of the mode of therapy, whether with hormone patches (0.40, 0.17-0.90) or with oral tablets (0.59, 0.39-0.90). In combination with estrogen, progestagens of the norethisterone and levonorgestrel families were associated with strong reduction in CRC risk
    Type of Publication: Journal article published
    PubMed ID: 19606090
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  • 10
    Keywords: CANCER ; MODEL ; LUNG-CANCER ; EXPOSURE ; RISK ; ASSOCIATION ; prevention ; WOMEN ; CIGARETTE-SMOKING ; smoking ; COLORECTAL-CANCER ; case-control studies ; case-control study ; CHILDHOOD ; EPIDEMIOLOGIC EVIDENCE ; PASSIVE SMOKING ; colorectal neoplasm
    Abstract: In a population-based case-control study in Germany, 540 incident cases of colorectal cancer (CRC) aged 〉= 30 years and 614 controls were recruited from January 2003 to June 2004. Information on risk factors of CRC and lifetime history of active smoking and exposure to environmental tobacco smoke (ETS) was obtained by personal interviews. This analysis is limited to never smokers (252 cases and 292 controls). Associations were assessed using conditional logistic regression models adjusting for potential confounders. We found no evidence of an increased risk of CRC following exposure to ETS overall, in childhood or at work. For spousal exposure, we, however, found a significant risk increase for women currently exposed (OR: 3.54; 95% Cl: 1.03-12.15) and for women exposed to 〉 23 pack-years of spousal smoking (OR: 3.02; 95% Cl: 0.99-9.28). Our findings do not indicate a major impact of ETS on CRC risk but suggest that risk may be increased following spousal exposure. European Journal of Cancer Prevention 18:9-12 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins
    Type of Publication: Journal article published
    PubMed ID: 19077559
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