Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
Filter
  • colonoscopy  (18)
  • 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
    Signatur Availability
    BibTip Others were also interested in ...
  • 2
    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
    Signatur Availability
    BibTip Others were also interested in ...
  • 3
    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
    Signatur Availability
    BibTip Others were also interested in ...
  • 4
    facet.materialart.
    facet.materialart.
    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
    Signatur Availability
    BibTip Others were also interested in ...
  • 5
    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
    Signatur Availability
    BibTip Others were also interested in ...
  • 6
    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
    Signatur Availability
    BibTip Others were also interested in ...
  • 7
    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
    Signatur Availability
    BibTip Others were also interested in ...
  • 8
    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
    Signatur Availability
    BibTip Others were also interested in ...
  • 9
    Keywords: CANCER ; carcinoma ; RISK ; PROTEIN ; POLYMORPHISMS ; AGE ; colonoscopy ; METAANALYSIS ; colorectal neoplasms ; Helicobacter pylori ; COLONIC ADENOMAS ; SEROPREVALENCE ; SEROPOSITIVITY ; ATROPHIC GASTRITIS ; ERADICATION ; HYPERGASTRINEMIA
    Abstract: Evidence concerning the role of Helicobacter pylori infection in the development of colorectal cancer remains controversial. The authors assessed the association of H. pylori seroprevalence with risk of colorectal cancer in a large population-based case-control study from Germany in 2003-2007. Serum antibodies to H. pylori in general and the cytotoxin-associated gene A protein (CagA) were measured in 1,712 incident colorectal cancer cases and 1,669 controls. The association between H. pylori seroprevalence and colorectal cancer risk was estimated by logistic regression, with adjustment for potential confounders and stratification by age group, sex, anatomic subsites, and cancer stage. Overall, H. pylori seroprevalence was higher in cases (46.1%) than in controls (40.1%), resulting in an age- and sex-adjusted odds ratio of 1.30 (95% confidence interval (CI): 1.14, 1.50). Adjustment for established colorectal cancer risk factors decreased the odds ratio to 1.26 (95% CI: 1.09, 1.47), with a further reduction to 1.18 (95% CI: 1.01, 1.38) after additional adjustment for previous colorectal endoscopy. Stratified analyses showed risk elevation to be essentially confined to left-sided colorectal cancer, with an odds ratio of 1.22 (95% CI: 1.02, 1.45), suggesting that H. pylori infection may be associated with a small yet relevant risk increase in the left colorectum.
    Type of Publication: Journal article published
    PubMed ID: 22294430
    Signatur Availability
    BibTip Others were also interested in ...
  • 10
    Keywords: ADENOMAS ; PATTERNS ; GUIDELINES ; PROGRAM ; UPDATE ; colonoscopy ; POLYPECTOMY ; NATIONAL-SURVEY ; POLYP SURVEILLANCE ; COMMUNITY PRACTICE
    Abstract: Background: Limited evidence exists on the utilization of surveillance colonoscopy in colorectal cancer (CRC) screening programs. We assessed adherence to physician recommendations for surveillance in opportunistic CRC screening in Germany. Methods: A follow-up study of screening colonoscopy participants in 2007-2009 in Saarland, Germany, was conducted using health insurance claims data. Utilization of additional colonoscopies through to 2011 was ascertained. Adherence to surveillance intervals of 3, 6, 12 and 36 months, defined as having had colonoscopy at 2.5 to 4, 5 to 8, 10.5 to 16 and 33 to 48 months, respectively (i.e., tolerating a delay of 33% of each interval) was assessed. Potential predictors of non-adherence were investigated using logistic regression analysis. Results: A total of 20,058 screening colonoscopy participants were included in the study. Of those with recommended surveillance intervals of 3, 6, 12 and 36 months, 46.5% (95%-confidence interval [CI]: 37.3-55.7%), 38.5% (95%-CI: 29.6-47.3%), 25.4% (95%-CI: 21.2-29.6%) and 28.0% (95%-CI: 25.5-30.5%), respectively, had a subsequent colonoscopy within the specified margins. Old age, longer recommended surveillance interval, not having had polypectomy at screening and negative colonoscopy were statistically significant predictors of non-adherence. Conclusion: This study suggests frequent non-adherence to physician recommendations for surveillance colonoscopy in community practice. Increased efforts to improve adherence, including introduction of more elements of an organized screening program, seem necessary to assure a high-quality CRC screening process.
    Type of Publication: Journal article published
    PubMed ID: 24324821
    Signatur Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...