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  • 11
    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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  • 12
    Abstract: BACKGROUND: Colorectal cancer is the most common cancer in Germany. Screening colonoscopies have been offered as a primary screening tool in Germany since the end of 2002. OBJECTIVE: To estimate the numbers of clinically manifest colorectal cancers prevented by detection and removal of advanced adenomas in the initial 6 years of the program. DESIGN: Markov model with single-year transitions. SETTING: German screening colonoscopy program. PATIENTS: Participants in the screening colonoscopy program from 2003 to 2008. INTERVENTIONS: Screening colonoscopy with the removal of advanced colorectal neoplasms. MAIN OUTCOME MEASUREMENTS: The expected numbers of incident colorectal cancers prevented by detection and removal of advanced adenomas. RESULTS: An estimated total number of 73,024 cases of colorectal cancer might have developed from the removed advanced adenomas and become clinically manifest between 55 and 84 years of age in the absence of screening colonoscopy. This number exceeds the number of colorectal cancers diagnosed in 2002 by 27%. Among prevented cancers, 8%, 43%, and 49% would have occurred at ages 55 to 64, 65 to 74, and 75 to 84 years (median age 74 years), respectively; 60% and 40% would have occurred among men and women, respectively; and 22%, 32%, 25%, and 20% would have occurred within 1 to 5, 6 to 10, 11 to 15, and 16 to 30 years, respectively, after colonoscopy (median 10 years). LIMITATIONS: Diagnoses of advanced adenomas are based on records from a large number of endoscopists and pathology laboratories. CONCLUSIONS: Despite relatively low screening participation, the German screening colonoscopy program is expected to make a major contribution to the prevention of colorectal cancer, even though most of the impact will only be seen in the longer run.
    Type of Publication: Journal article published
    PubMed ID: 20883856
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  • 13
    Abstract: Hintergrund: Seit Oktober 2002 ist die Früherkennungskoloskopie Bestandteil des deutschen Krebsfrüherkennungsprogramms. Ziel dieser Arbeit ist es, die Zahl der durch die Früherkennungskoloskopien in den Jahren 2003 bis 2010 verhüteten und vorzeitig erkannten Darmkrebsfälle abzuschätzen. Methoden: Teilnahmeraten und alters- und geschlechtsspezifische Prävalenzen fortgeschrittener Adenome und früh erkannter Karzinome wurden für die Jahre 2003 bis 2008 aus dem Nationalen Register der Früherkennungskoloskopien ermittelt. Für die Jahre 2009 und 2010 wurden die im Jahr 2008 beobachteten Werte zugrunde gelegt. Diese Daten wurden in Markov-Modellen, unter Berücksichtigung von Sterberaten, mit den jeweiligen Bevölkerungsziffern und den aus der Literatur verfügbaren Schätzungen von Übergangsraten zwischen fortgeschrittenen Adenomen, präklinischen und klinisch manifesten Karzinomen kombiniert. Ergebnisse: Man schätzt, dass bis Ende 2010 durch die Früherkennungskoloskopie bei Personen im Alter von 55 bis 84 Jahren bundesweit 98 734 Darmkrebsfälle verhütet und weitere 47 168 Darmkrebserkrankungen frühzeitig, oft in einem heilbaren Stadium, erkannt sein werden. Die verhüteten Fälle wären ohne Entfernung der fortgeschrittenen Adenome im Median 10 Jahre nach der Früherkennungskoloskopie klinisch manifest geworden. Schlussfolgerung: Trotz verbesserungsfähiger Teilnahmequote leistet die Früherkennungskoloskopie einen sehr großen Beitrag zur Verhütung und Früherkennung kolorektaler Karzinome in Deutschland.
    Type of Publication: Journal article published
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  • 14
    Keywords: POPULATION ; PERFORMANCE ; PLASMA ; MARKERS ; CARCINOEMBRYONIC ANTIGEN ; GASTRIC-CANCER ; OCCULT BLOOD-TESTS ; COLORECTAL ADENOMA DETECTION ; AVERAGE RISK ; SERUM PEPSINOGEN
    Abstract: Objectives: In the evaluation of cancer screening tests, cancer-free controls are often matched to cancer cases on factors such as sex and age. We assessed the potential merits and pitfalls of such matching using an example from colorectal cancer (CRC) screening. Study Design and Setting: We compared sex and age distribution of CRC cases and cancer-free people undergoing screening colonoscopy in Germany in 2006 and 2007. We assessed specificity by sex and age of two immunochemical fecal occult blood tests (iFOBTs) in a study among screening colonoscopy participants conducted in the same years, and we assessed the expected impact of matching by sex and age on the validity of specificity estimates at various cut points. Results: In the screening colonoscopy program, the proportion of men and mean age were 59.6% and 68.6 years among 10,324 CRC patients compared with 45.6% and 64.7 years, respectively, among 997,490 cancer-free participants. The specificity of the iFOBTs was higher among women than among men and decreased with age. Matching of cancer-free controls by age and sex would have led to the underestimation of specificity at all cut points assessed. Conclusion: In the evaluation of cancer screening tests, matching of controls may lead to biased estimates of specificity.
    Type of Publication: Journal article published
    PubMed ID: 23257151
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  • 15
    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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  • 16
    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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  • 17
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  • 18
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  51. Kongress für Allgemeinmedizin und Familienmedizin; 20170921-20170923; Düsseldorf; DOC17degam290 /20170905/
    Publication Date: 2017-09-05
    Keywords: Bürgerteiligung ; HTA ; ThemenCheck Medizin ; ddc: 610
    Language: German
    Type: conferenceObject
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  • 19
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  Klasse statt Masse - wider die wertlose Wissenschaft; 18. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin; 20170309-20170311; Hamburg; DOC17ebmW2 /20170223/
    Publication Date: 2017-02-23
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 20
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  12. Deutscher Kongress für Versorgungsforschung; 20131023-20131025; Berlin; DOCKV13-12 /20131025/
    Publication Date: 2013-10-26
    Keywords: Disease Management ; DMP Asthma ; Time-To-Event ; medikamentöse Therapie ; Leitlinien ; ddc: 610
    Language: German
    Type: conferenceObject
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