Long-Term Colorectal-Cancer Incidence and Mortality after Lower Endoscopy

By Reiko Nishihara, Kana Wu, P. Lochhead, Teppei Morikawa, X. Liao, Z. Qian, K. Inamura, S. Kim, A. Kuchiba, Mai Yamauchi and 7 more. New England Journal of Medicine, 2013

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BACKGROUND Colonoscopy and sigmoidoscopy provide protection against colorectal cancer, but the magnitude and duration of protection, particularly against cancer of the proximal colon, remain uncertain. METHODS We examined the association of the use of lower endoscopy (updated biennially from 1988 through 2008) with colorectal-cancer incidence (through June 2010) and colorectal-cancer mortality (through June 2012) among participants in the Nurses’ Health Study and the Health Professionals Follow-up Study. RESULTS Among 88,902 participants followed over a period of 22 years, we documented 1815 incident colorectal cancers and 474 deaths from colorectal cancer. With endoscopy as compared with no endoscopy, multivariate hazard ratios for colorectal cancer were 0.57 (95% confidence interval [CI], 0.45 to 0.72) after polypectomy, 0.60 (95% CI, 0.53 to 0.68) after negative sigmoidoscopy, and 0.44 (95% CI, 0.38 to 0.52) after negative colonoscopy. Negative colonoscopy was associated with a reduced incidence of proximal colon cancer (multivariate hazard ratio, 0.73; 95% CI, 0.57 to 0.92). Multivariate hazard ratios for death from colorectal cancer were 0.59 (95% CI, 0.45 to 0.76) after screening sigmoidoscopy and 0.32 (95% CI, 0.24 to 0.45) after screening colonoscopy. Reduced mortality from proximal colon cancer was observed after screening colonoscopy (multivariate hazard ratio, 0.47; 95% CI, 0.29 to 0.76) but not after sigmoidoscopy. As compared with colorectal cancers diagnosed in patients more than 5 years after colonoscopy or without any prior endoscopy, those diagnosed in patients within 5 years after colonoscopy were more likely to be characterized by the CpG island methylator phenotype (CIMP) (multivariate odds ratio, 2.19; 95% CI, 1.14 to 4.21) and microsatellite instability (multivariate odds ratio, 2.10; 95% CI, 1.10 to 4.02). CONCLUSIONS Colonoscopy and sigmoidoscopy were associated with a reduced incidence of cancer of the distal colorectum; colonoscopy was also associated with a modest reduction in the incidence of proximal colon cancer. Screening colonoscopy and sigmoidoscopy were associated with reduced colorectal-cancer mortality; only colonoscopy was associated with reduced mortality from proximal colon cancer. Colorectal cancer diagnosed within 5 years after colonoscopy was more likely than cancer diagnosed after that period or without prior endoscopy to have CIMP and microsatellite instability. (Funded by the National Institutes of Health and others.)

Subfields: Oncology, Pulmonary and Respiratory Medicine

View Paper: https://www.semanticscholar.org/paper/778a578187bee44d1da1af275742817bc03017d3

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Citations in the corpus

Annual Report to the Nation on the Status of Cancer, 1975–2012, Featuring the Increasing Incidence of Liver Cancer (2016, neutral): “61 Still, a recent report about the use of colorectal cancer screening indicated that 35% of US adults were not up to date with one of the colorectal cancer screening tests recommended by the USPSTF.”
ACG Clinical Guidelines: Colorectal Cancer Screening 2021. (2021, background): “Double examination has frequently been focused on the cecum and ascending colon (165) because several studies indicate that colonoscopy is less effective in preventing right-sided compared with left-sided CRC (11,13,16,133).”
Colorectal cancer statistics, 2023 (2023, background): “Observational studies suggest that colonoscopy reduces CRC incidence by about 40% and mortality by about 60%.(41,42,128) The prevalence of reported up‐to‐ date screening with any recommended test among individuals aged 50 years and older increased from 38% in 2000 to 66% in 2018 according to data fr”
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Early detection of cancer (2022, positive): “Several existing screening tests improve cancer-specific mortality or overall mortality, including mammography for breast cancer (46), the Pap smear for cervical cancer (47), colonoscopy for colorectal cancer (48), and low-dose computed tomography (CT) (49) for lung cancer.”