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Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study
Quantitative Health Sciences Publications and Presentations
  • Chyke A. Doubeni, University of Massachusetts Medical School
  • Sheila Weinmann, Kaiser Permanente Northwest
  • Kenneth Adams, HealthPartners Institute for Education and Research
  • Aruna Kamineni, Group Health Research Institute
  • Diana S. M. Buist, Group Health Center for Health Studies
  • Arlene S. Ash, University of Massachusetts Medical School
  • Carolyn M. Rutter, Group Health Research Institute
  • V. Paul Doria-Rose, National Institutes of Health
  • Douglas A. Corley, Kaiser Permanente
  • Robert T. Greenlee, Marshfield Clinic Research Foundation
  • Jessica Chubak
  • Andrew E. Williams, Kaiser Permanente
  • Aimee R. Kroll-Desrosiers, University of Massachusetts Medical School
  • Eric Johnson, University of Massachusetts Medical School
  • Joseph Webster, Group Health Research Institute
  • Kathryn Richert-Boe, Kaiser Permanente Northwest
  • Theodore R. Levin, The Permanente Medical Group
  • Robert H. Fletcher, Harvard Medical School
  • Noel S. Weiss, University of Washington
UMMS Affiliation
Department of Quantitative Health Sciences; Department of Pathology; Department of Family Medicine and Community Health; Meyers Primary Care Institute
Date
3-5-2013
Document Type
Article
Medical Subject Headings
Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Mass Screening
Abstract
BACKGROUND: The effectiveness of screening colonoscopy in average-risk adults is uncertain, particularly for right colon cancer. OBJECTIVE: To examine the association between screening colonoscopy and risk for incident late-stage colorectal cancer (CRC). DESIGN: Nested case-control study. SETTING: Four U.S. health plans. PATIENTS: 1039 average-risk adults enrolled for at least 5 years in one of the health plans. Case patients were aged 55 to 85 years on their diagnosis date (reference date) of stage IIB or higher (late-stage) CRC during 2006 to 2008. One or 2 control patients were selected for each case patient, matched on birth year, sex, health plan, and prior enrollment duration. MEASUREMENTS: Receipt of CRC screening 3 months to 10 years before the reference date, ascertained through medical record audits. Case patients and control patients were compared on receipt of screening colonoscopy or sigmoidoscopy by using conditional logistic regression that accounted for health history, socioeconomic status, and other screening exposures. RESULTS: In analyses restricted to 471 eligible case patients and their 509 matched control patients, 13 case patients (2.8%) and 46 control patients (9.0%) had undergone screening colonoscopy, which corresponded to an adjusted odds ratio (AOR) of 0.29 (95% CI, 0.15 to 0.58) for any late-stage CRC, 0.36 (CI, 0.16 to 0.80) for right colon cancer, and 0.26 (CI, 0.06 to 1.11; P = 0.069) for left colon/rectum cancer. Ninety-two case patients (19.5%) and 173 control patients (34.0%) had screening sigmoidoscopy, corresponding to an AOR of 0.50 (CI, 0.36 to 0.70) overall, 0.79 (CI, 0.51 to 1.23) for right colon late-stage cancer, and 0.26 (CI, 0.14 to 0.48) for left colon cancer. LIMITATION: The small number of screening colonoscopies affected the precision of the estimates. CONCLUSION: Screening with colonoscopy in average-risk persons was associated with reduced risk for diagnosis of incident late-stage CRC, including right-sided colon cancer. For sigmoidoscopy, this association was seen for left CRC, but the association for right colon late-stage cancer was not statistically significant. PRIMARY FUNDING SOURCE: National Cancer Institute of the National Institutes of Health.
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Citation: Ann Intern Med. 2013;158(5_Part_1):312-320. doi:10.7326/0003-4819-158-5-201303050-00003. Link to article on publisher's site

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Link to Article in PubMed
Citation Information
Chyke A. Doubeni, Sheila Weinmann, Kenneth Adams, Aruna Kamineni, et al.. "Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study" Vol. 158 Iss. 5 Pt 1 (2013) ISSN: 0003-4819 (Linking)
Available at: http://works.bepress.com/arlene_ash/153/