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Wooldrage K, Robbins EC, Duffy SW, Cross AJ. Long-term effects of once-only flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: 21-year follow-up of the UK Flexible Sigmoidoscopy Screening randomised controlled trial. Lancet Gastroenterol Hepatol 2024; 9:811-824. [PMID: 39038482 DOI: 10.1016/s2468-1253(24)00190-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Flexible sigmoidoscopy screening reduces colorectal cancer incidence and mortality; however, uncertainty exists about the duration of protection and differences by sex and age. We assessed effects of once-only flexible sigmoidoscopy screening after 21 years' follow-up. METHODS The UK Flexible Sigmoidoscopy Screening Trial is a multicentre randomised controlled trial that recruited men and women aged 55-64 years from general practices serving 14 hospitals. Among participants indicating that they would attend flexible sigmoidoscopy screening if invited, randomisation (2:1) to the control (no further contact) or intervention (invited to once-only flexible sigmoidoscopy screening) group was performed centrally in blocks of 12, stratified by centre, general practice, and household type. Masking of intervention was infeasible. Primary outcomes were colorectal cancer incidence and mortality. The Kaplan-Meier method estimated cumulative incidence. Primary analyses estimated intention-to-treat hazard ratios (HRs) and risk differences, overall and stratified by subsite, sex, and age. The trial is registered with ISRCTN, number 28352761. FINDINGS Among participants recruited between Nov 14, 1994, and March 30, 1999, 170 432 were eligible and 113 195 were randomly assigned to the control group and 57 237 were randomly assigned to the intervention group. 406 participants were excluded from analyses (268 in the control group and 138 in the intervention group), leaving 112 927 participants in the control group (55 336 [49%] men and 57 591 [51%] women) and 57 099 in the intervention group (27 966 [49%] men and 29 103 [51%] women). Of participants who were invited to be screened, 40 624 (71%) attended screening. Median follow-up was 21·3 years (IQR 18·0-22·2). In the invited-to-screening group, colorectal cancer incidence was reduced compared with the control group (1631 vs 4201 cases; cumulative incidence at 21 years was 3·18% [95% CI 3·03 to 3·34] vs 4·16% [4·04 to 4·29]; HR 0·76 [95% CI 0·72 to 0·81]) with 47 fewer cases per 100 000 person-years (95% CI -56 to -37). Colorectal cancer mortality was also reduced in the invited-to-screening group compared with the control group (502 vs 1329 deaths; cumulative incidence at 21 years was 0·97% [0·88 to 1·06] vs 1·33% [1·26 to 1·40]; HR 0·75 [0·67 to 0·83]) with 16 fewer deaths per 100 000 person-years (-21 to -11). Effects were particularly evident in the distal colorectum (726 incident cancer cases in the invited-to-screening group vs 2434 cases in the control group; HR 0·59 [0·54 to 0·64]; 47 fewer cases per 100 000 person-years [-54 to -41]; 196 cancer deaths in the invited-to-screening group vs 708 deaths in the control group; HR 0·55 [0·47 to 0·64]; 15 fewer deaths per 100 000 person-years [-19 to -12]) and not the proximal colon (871 incident cancer cases in the invited-to-screening group vs 1749 cases in the control group; HR 0·98 [0·91 to 1·07]; one fewer case per 100 000 person-years [-8 to 5]; 277 cancer deaths in the invited-to-screening group vs 547 deaths in the control group; HR 1·00 [0·86 to 1·15]; zero fewer deaths per 100 000 person-years [-4 to 4]). The HR for colorectal cancer incidence was lower in men (0·70 [0·65-0·76]) than women (0·86 [0·79 to 0·93]; pinteraction=0·0007) but there was no difference by age. INTERPRETATION We show that once-only flexible sigmoidoscopy screening reduces colorectal cancer incidence and mortality for two decades and provide important data to inform colorectal cancer screening guidelines. FUNDING National Institute for Health and Care Research Health Technology Assessment Programme and the Medical Research Council.
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Affiliation(s)
- Kate Wooldrage
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Emma C Robbins
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephen W Duffy
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Amanda J Cross
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
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Janduang S, Cotchim S, Kongkaew S, Srilikhit A, Wannapob R, Kanatharana P, Thavarungkul P, Limbut W. Synthesis of flower-like ZnO nanoparticles for label-free point of care detection of carcinoembryonic antigen. Talanta 2024; 277:126330. [PMID: 38833905 DOI: 10.1016/j.talanta.2024.126330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 05/21/2024] [Accepted: 05/26/2024] [Indexed: 06/06/2024]
Abstract
In this work, flower-like ZnO nanoparticles (ZnONPs) were synthesized using zinc nitrate (Zn(NO3)2 6H2O) as a precursor with KOH. The morphology of the ZnONPs was controlled by varying the synthesis temperature at 50, 75 and 95 °C. The morphology and structure of ZnONPs were characterized using Scanning Electron Microscopy, and X-Ray Diffraction and Brunauer-Emmett Teller analysis. ZnONPs were successfully synthesized by a simple chemical precipitation method. A synthesis temperature of 75 °C produced the most suitable flower-like ZnONPs, which were combined with graphene nanoplatelets to develop a label-free electrochemical immunosensor for the detection of the colon cancer biomarker carcinoembryonic antigen in human serum. Under optimum conditions, the developed immunosensor showed a linear range of 0.5-10.0 ng mL-1 with a limit of detection of 0.44 ng mL-1. The label-free electrochemical immunosensor exhibited good selectivity, reproducibility, and repeatability, and recoveries were excellent. The immunosensor is used with a Near-Field Communication potentiostat connected to a smartphone to facilitate point-of-care cancer detection in low-resource locations.
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Affiliation(s)
- Santipap Janduang
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Suparat Cotchim
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Supatinee Kongkaew
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Angkana Srilikhit
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Rodtichoti Wannapob
- Silicon Craft Technology PLC, No. 40, Thetsabanrangsannua Rd., Ladyao, Chatuchak, Bangkok, 10900, Thailand
| | - Proespichaya Kanatharana
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Panote Thavarungkul
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Warakorn Limbut
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand; Forensic Science Innovation and Service Center, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
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Brenner H, Heisser T, Cardoso R, Hoffmeister M. The underestimated preventive effects of flexible sigmoidoscopy screening: re-analysis and meta-analysis of randomized trials. Eur J Epidemiol 2024; 39:743-751. [PMID: 38642235 PMCID: PMC11343976 DOI: 10.1007/s10654-024-01120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
Flexible sigmoidoscopy (FS), which is less invasive, resource intensive and costly than colonoscopy, is among the recommended screening options for colorectal cancer (CRC). Four large randomized trials consistently reported statistically significant, albeit modest effects of screening by FS on CRC incidence. However, their effect estimates included cancers that were already prevalent at recruitment and could not have been prevented by screening. We performed a re-analysis and meta-analysis of two of the trials (including the largest one) to estimate reduction of truly incident cases by a single FS offered between 55 and 64 years of age among the "at risk study population" without prevalent CRC at recruitment. In meta-analyses of data reported after more than 15 years of follow-up, relative risk (95% CI) in intention-to-screen and per-protocol analyses were 0.71 (0.66-0.76) and 0.59 (0.55-0.65) for any CRC, and 0.52 (0.47-0.57) and 0.34 (0.30-0.39) for distal CRC, respectively. These results indicate much stronger effects than those suggested by the original reports and imply that a single screening FS can prevent approximately two out of three distal incident CRC cases within 15 + years of follow-up.
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Affiliation(s)
- Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), INF 581, Heidelberg, 69120, Germany.
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), INF 581, Heidelberg, 69120, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Rafael Cardoso
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), INF 581, Heidelberg, 69120, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), INF 581, Heidelberg, 69120, Germany
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Zhang Y, Zhang XB, Ding YW, Kong Y, Zhu XF, Li PH, Tian Y, Zhang QW. Distinct time trends in colorectal cancer incidence in countries with SDI levels from 1990 to 2019: an age-period-cohort analysis for the Global Burden of Disease 2019 study. Front Public Health 2024; 12:1370282. [PMID: 38841678 PMCID: PMC11150799 DOI: 10.3389/fpubh.2024.1370282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction The burden of colorectal cancer (CRC) plays a pivotal role in the global cancer epidemic. Our study reported the incidence trends in CRC and the associated effects of age, period, and birth cohort in 204 countries and territories over the past 30 years. Methods The incidence data of CRC were extracted from the Global Burden of Disease Study (GBD) 2019. We performed the age-period-cohort (APC) model to estimate the overall annual percentage change (net drift) in the incidence rate, the annual percentage change by age group (local drift), and the relative risk (period and cohort effects) of the period and cohort in CRC during 1990-2019. This approach allows examining and distinguishing age, period, and cohort effects in incidence and potentially distinguishing colorectal cancer gaps in prevention and screening. Results In 2019, the incidence of CRC was 2.17 (95% UI 2.00-2.34) million, of which China, the United States of America, and Japan had the highest incidence population, accounting for 45.9% of the global population. The age-standardized incidence rate (ASIR) was 26.7 (95% UI 28.9-24.6) per 100,000 people, of which 30 countries had an incidence rate greater than 40.0 per 100,000 people. From 1990 to 2019, the middle SDI region had the largest increase in incidence rate, with a net drift of 2.33% (95% CI 2.2-2.46%, p < 0.001). Globally, the incidence population was concentrated in the age group of 50-69 years, and the age group of 30-34 years had the largest increase in incidence rate (local drift 1.19% (95% CI 1.01-1.37%)). At the same time, the sex and age distributions of CRC incidence had significant heterogeneity across regions and countries. In the past 30 years, the incidence rate in 31 countries has been well controlled (net drift <0), and most of them were concentrated in high-and high-middle-SDI regions, such as Australia, Czechia, and Belgium, and the relative risk of incidence generally improved over time and consecutive young birth cohorts. CRC incidence showed an unfavorable trend (net drift ≥1%) in 89 countries, of which 27 countries were more significant (net drift >2%), mostly concentrated in the middle SDI region, such as China, Mexico, and Brazil, and the risk of period and birth cohort was unfavorable. Conclusion Globally, the incidence of CRC has shown an overall upward trend over the past 30 years, with the exception of some countries with higher SDI values. Significant age-period-cohort differences were observed in the risk of incidence in CRC worldwide. Effective prevention and control policies need to take into account the age-period-cohort effect characteristics of different regions.
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Affiliation(s)
- Yan Zhang
- Department of Medical Oncology, Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xun-Bing Zhang
- Department of Digestive Endoscopy Center, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu-Wei Ding
- Department of Medical Oncology, Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yang Kong
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao-Feng Zhu
- Department of Hepatobiliary and Pancreatic Surgery, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Pu-Heng Li
- School of Mathematical Sciences, Peking University, Beijing, China
| | - Yang Tian
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qing-Wei Zhang
- Division of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Diseases, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Heisser T, Senore C, Hoffmeister M, Jansen L, Brenner H. Disclosing the true impact of screening endoscopy in colorectal cancer prevention. Cancer Commun (Lond) 2024; 44:504-507. [PMID: 38495017 PMCID: PMC11024681 DOI: 10.1002/cac2.12531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/10/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Thomas Heisser
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergBaden‐WürttembergGermany
| | - Carlo Senore
- Epidemiology and Screening UnitReference Centre for Epidemiology and Cancer Prevention, University Hospital Città della Salute e della ScienzaTurinPiedmontItaly
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergBaden‐WürttembergGermany
| | - Lina Jansen
- Epidemiological Cancer Registry Baden‐Württemberg, German Cancer Research Center (DKFZ)HeidelbergBaden‐WürttembergGermany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ)HeidelbergBaden‐WürttembergGermany
- Division of Preventive OncologyGerman Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT)HeidelbergBaden‐WürttembergGermany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ)HeidelbergBaden‐WürttembergGermany
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6
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Heisser T, Sergeev D, Hoffmeister M, Brenner H. Contributions of early detection and cancer prevention to colorectal cancer mortality reduction by screening colonoscopy: a validated modeling study. Gastrointest Endosc 2024:S0016-5107(24)00163-9. [PMID: 38462054 DOI: 10.1016/j.gie.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/17/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND AIMS Screening colonoscopy, recommended every 10 years, reduces mortality from colorectal cancer (CRC) by early detection of prevalent but undiagnosed CRC, as well as by removal of precursor lesions. The aim of this study was to assess the relative contribution of both components to total CRC mortality reduction over time. METHODS Using a validated multistate Markov model, we simulated hypothetical cohorts of 100,000 individuals aged 55 to 64 years with and without screening at baseline. Main outcomes included proportions of prevented CRC deaths arising from (asymptomatic) CRC already present at baseline and from newly developed CRC during 15 years of follow-up, and mortality rate ratios of screened versus nonscreened groups over time. RESULTS Early detection of prevalent cases accounted for 52%, 30%, and 18% of deaths prevented by screening colonoscopy within 5, 10, and 15 years, respectively. Relative reduction of mortality was estimated to be much larger for mortality from incident cancers than for mortality from cancers that were already present and detected early at screening endoscopy and for total CRC mortality (ie, 88% versus 67% and 79%, respectively, within 10 years from screening). CONCLUSIONS Reduction of CRC mortality mainly arises from early detection of prevalent cancers during the early years after screening colonoscopy, but prevention of incident cases accounts for the majority of prevented deaths in the longer run. Prevention of incident cases leads to sustained strong reduction of CRC mortality, possibly warranting an extension of screening intervals.
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Affiliation(s)
- Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Dmitry Sergeev
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
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7
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Wang D, Xu Q, Dai S, Zhang Y, Ding F, Ji L. Effects of sigmoidoscopy screening (including colonoscopy) on colorectal cancer: A meta-analysis based on randomized controlled trials. Prev Med Rep 2024; 39:102636. [PMID: 38333601 PMCID: PMC10847765 DOI: 10.1016/j.pmedr.2024.102636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
Background This study aimed to investigate the role of endoscopy screening in colorectal cancer (CRC). Methods Up to January 2023, databases were searched for studies related to sigmoidoscopy and colonoscopy screening. The incidence of CRC, and/or CRC mortality were the main observation outcomes. Results A total of 5 randomized controlled trials (RCTs) published from 2017 to 2022 were included. Among them, four studies used sigmoidoscopy screening and one study involved colonoscopy screening. Statistical results showed that the incidence (RR: 0.78, p < 0.001) and mortality (RR: 0.75, p < 0.001) of CRC were significantly lower in the screening group than in the control group. Further, a subgroup analysis of CRC site indicated that the incidence and mortality of CRC in the screening group were significantly lower than those in the non-screened group, regardless of distal CRC (Incidence: RR: 0.66, p < 0.001; Mortality: RR: 0.62, p < 0.001) or proximal CRC (Incidence: RR: 0.94, p = 0.038; Mortality: RR: 0.89, p = 0.038). In terms of gender, compared with the non-screening group, both males (Incidence: RR: 0.73, p < 0.001; Mortality: RR: 0.68, p < 0.001) and females (Incidence: RR: 0.85, p < 0.001; Mortality: RR: 0.85, p = 0.017), the screening group had a significant decrease in the incidence and mortality of CRC. Conclusion This meta-analysis demonstrated that sigmoidoscopy screening (including colonoscopy) could effectively reduce the incidence and mortality of CRC.
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Affiliation(s)
- Dongying Wang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qian Xu
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Senjie Dai
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yueming Zhang
- Intensive Care Unit, Hospital of Zhejiang People's Armed Police, Hangzhou, Zhejiang, China
| | - Fulin Ding
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Linling Ji
- Outpatient Nursing, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
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Sano Y, Hotta K, Matsuda T, Murakami Y, Fujii T, Kudo SE, Oda Y, Ishikawa H, Saito Y, Kobayashi N, Sekiguchi M, Ikematsu H, Katagiri A, Konishi K, Takeuchi Y, Iishi H, Igarashi M, Kobayashi K, Sada M, Osera S, Shinohara T, Yamaguchi Y, Hasuda K, Morishima T, Miyashiro I, Shimoda T, Taniguchi H, Fujimori T, Ajioka Y, Yoshida S. Endoscopic Removal of Premalignant Lesions Reduces Long-Term Colorectal Cancer Risk: Results From the Japan Polyp Study. Clin Gastroenterol Hepatol 2024; 22:542-551.e3. [PMID: 37544420 DOI: 10.1016/j.cgh.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND & AIMS To date, no regional evidence of long-term colorectal cancer (CRC) risk reduction after endoscopic premalignant lesion removal has been established. We aimed to analyze this over a long-term follow-up evaluation. METHODS This was a prospective cohort study of participants from the Japan Polyp Study conducted at 11 Japanese institutions. Participants underwent scheduled follow-up colonoscopies after a 2-round baseline colonoscopy process. The primary outcome was CRC incidence after randomization. The observed/expected ratio of CRC was calculated using data from the population-based Osaka Cancer Registry. Secondary outcomes were the incidence and characteristics of advanced neoplasia (AN). RESULTS A total of 1895 participants were analyzed. The mean number of follow-up colonoscopies and the median follow-up period were 2.8 years (range, 1-15 y) and 6.1 years (range, 0.8-11.9 y; 11,559.5 person-years), respectively. Overall, 4 patients (all males) developed CRCs during the study period. The observed/expected ratios for CRC in all participants, males, and females, were as follows: 0.14 (86% reduction), 0.18, and 0, respectively, and 77 ANs were detected in 71 patients (6.1 per 1000 person-years). Of the 77 ANs detected, 31 lesions (40.3%) were laterally spreading tumors, nongranular type. Nonpolypoid colorectal neoplasms (NP-CRNs), including flat (<10 mm), depressed, and laterally spreading, accounted for 59.7% of all detected ANs. Furthermore, 2 of the 4 CRCs corresponded to T1 NP-CRNs. CONCLUSIONS Endoscopic removal of premalignant lesions, including NP-CRNs, effectively reduced CRC risk. More than half of metachronous ANs removed by surveillance colonoscopy were NP-CRNs. The Japan Polyp Study: University Hospital Medical Information Network Clinical Trial Registry: University Hospital Medical Information Network Clinical Trial Registry, C000000058; cohort study: UMIN000040731.
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Affiliation(s)
- Yasushi Sano
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care, Sano Hospital, Kobe, Japan.
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Sunto, Japan.
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.
| | | | | | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yasushi Oda
- Oda Gastrointestinal Endoscopy and Gastroenterology Clinic, Kumamoto, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Nozomu Kobayashi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan; Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Atsushi Katagiri
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kazuo Konishi
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyasu Iishi
- Department of Gastroenterology, Itami City Hospital, Itami, Japan
| | - Masahiro Igarashi
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kiyonori Kobayashi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Miwa Sada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shozo Osera
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Tomoaki Shinohara
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Saku, Japan
| | | | - Kiwamu Hasuda
- Hattori Gastrointestinal Endoscopy and Gastroenterology Clinic, Kumamoto, Japan
| | | | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Hirokazu Taniguchi
- Pathology and Clinical Laboratory Division, JR Tokyo General Hospital, Tokyo, Japan
| | | | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Heisser T, Hoffmeister M, Brenner H. Significant underestimation of preventive effects in colorectal cancer screening trial. Gut 2024; 73:556-558. [PMID: 36882193 PMCID: PMC10894833 DOI: 10.1136/gutjnl-2022-329165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/07/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Research Center, Heidelberg, Germany
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
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10
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Montalvan-Sanchez EE, Norwood DA, Dougherty M, Beas R, Guranizo-Ortiz M, Ramirez-Rojas M, Morgan DR, Imperiale TF. Colorectal Cancer Screening Programs in Latin America: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2354256. [PMID: 38300621 PMCID: PMC10835514 DOI: 10.1001/jamanetworkopen.2023.54256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
Importance Colorectal cancer (CRC) is a leading cause of cancer-related mortality globally, with increasing incidence and mortality in Latin America. CRC screening programs can reduce disease burden, but information on screening programs in Latin America is limited. Objective To describe characteristics (eg, type of program, uptake, neoplastic yield) of CRC screening programs in Latin America. Data Sources PubMed, Ovid MEDLINE, EMBASE, Cochrane, PsycINFO, Web of Science Core Collection, LILACS, and SciELO were searched from inception to February 2023. Relevant references from bibliographies, conference proceedings, and gray literature were considered. The search strategy included English, Spanish, and Portuguese terms. Study Selection Included were studies of CRC screening programs in Latin America using fecal immunochemical test (FIT) or colonoscopy as the primary screening method. Four reviewers independently assessed study eligibility based on titles, with review of abstracts and full texts as needed. Data Extraction and Synthesis Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed for data abstraction and quality assessment. Descriptive information was extracted, and data were pooled using a random-effects model. Main outcomes and Measures Program performance indicators included rates of participation and FIT positivity, adenoma detection rate (ADR), advanced adenoma detection rate (AADR), CRC detection rate, and colonoscopy quality indicators. Results There were 17 studies included from upper middle-income and high-income countries in Latin America with a total of 123 929 participants. Thirteen studies used FIT as the initial screening method, whereas 4 used screening colonoscopy. The participation rate in FIT-based programs was 85.8% (95% CI, 78.5%-91.4%). FIT positivity rates were 15.2% (95% CI, 9.6%-21.8%) for the 50-ng/mL threshold and 9.7% (95% CI, 6.8%-13.0%) for the 100-ng/mL threshold. For FIT-based studies, the pooled ADR was 39.0% (95% CI, 29.3%-49.2%) and CRC detection rate was 4.9% (95% CI, 2.6%-7.9%); for screening colonoscopy-based studies, the pooled ADR was 19.9% (95% CI, 15.5%-24.8%) and CRC detection rate was 0.4% (95% CI, 0.1%-0.8%). Conclusions and Relevance This systematic review and meta-analysis suggests that CRC screening in upper middle-income countries in Latin America is feasible, detecting rates of neoplasia comparable with those of high-income regions. Population-based screening programs should be developed or enhanced in these settings. There is a knowledge gap regarding feasibility and yield of screening programs in lower middle-income countries.
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Affiliation(s)
| | - Dalton A. Norwood
- Division of Preventive Medicine, The University of Alabama at Birmingham, Birmingham
| | - Michael Dougherty
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill
- UNC Rex Digestive Healthcare, Raleigh, North Carolina
| | - Renato Beas
- Department of Medicine, Indiana University School of Medicine, Indianapolis
| | | | | | - Douglas R. Morgan
- Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham
| | - Thomas F. Imperiale
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis
- Regenstrief Institute, Indianapolis, Indiana
- The Indiana University Simon Cancer Center, Indianapolis
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11
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Juul FE, Cross AJ, Schoen RE, Senore C, Pinsky PF, Miller EA, Segnan N, Wooldrage K, Wieszczy-Szczepanik P, Armaroli P, Garborg KK, Adami HO, Hoff G, Kalager M, Bretthauer M, Holme Ø, Løberg M. Effectiveness of Colonoscopy Screening vs Sigmoidoscopy Screening in Colorectal Cancer. JAMA Netw Open 2024; 7:e240007. [PMID: 38421651 PMCID: PMC10905314 DOI: 10.1001/jamanetworkopen.2024.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
Importance Randomized clinical screening trials have shown that sigmoidoscopy screening reduces colorectal cancer (CRC) incidence and mortality. Colonoscopy has largely replaced sigmoidoscopy for CRC screening, but long-term results from randomized trials on colonoscopy screening are still lacking. Objective To estimate the additional screening benefit of colonoscopy compared with sigmoidoscopy. Design, Setting, and Participants This comparative effectiveness simulation study pooled data on 358 204 men and women randomly assigned to sigmoidoscopy screening or usual care in 4 randomized sigmoidoscopy screening trials conducted in Norway, Italy, the US, and UK with inclusion periods in the years 1993 to 2001. The primary analysis of the study was conducted from January 19 to December 30, 2021. Intervention Invitation to endoscopic screening. Main Outcomes and Measures Primary outcomes were CRC incidence and mortality. Using pooled 15-year follow-up data, colonoscopy screening effectiveness was estimated assuming that the efficacy of colonoscopy in the proximal colon was similar to that observed in the distal colon in the sigmoidoscopy screening trials. The simulation model was validated using data from Norwegian participants in a colonoscopy screening trial. Results This analysis included 358 204 individuals (181 971 women [51%]) aged 55 to 64 years at inclusion with a median follow-up time ranging from 15 to 17 years. Compared with usual care, colonoscopy prevented an estimated 50 (95% CI, 42-58) CRC cases per 100 000 person-years, corresponding to 30% incidence reduction (rate ratio, 0.70 [95% CI, 0.66-0.75]), and prevented an estimated 15 (95% CI, 11-19) CRC deaths per 100 000 person-years, corresponding to 32% mortality reduction (rate ratio, 0.68 [95% CI, 0.61-0.76]). The additional benefit of colonoscopy screening compared with sigmoidoscopy was 12 (95% CI, 10-14) fewer CRC cases and 4 (95% CI, 3-5) fewer CRC deaths per 100 000 person-years, corresponding to percentage point reductions of 6.9 (95% CI, 6.0-7.9) for CRC incidence and 7.6 (95% CI, 5.7-9.6) for CRC mortality. The number needed to switch from sigmoidoscopy to colonoscopy screening was 560 (95% CI, 486-661) to prevent 1 CRC case and 1611 (95% CI, 1275-2188) to prevent 1 CRC death. Conclusions and Relevance The findings of this comparative effectiveness study assessing long-term follow-up after CRC screening suggest that there was an additional preventive effect on CRC incidence and mortality associated with colonoscopy screening compared with sigmoidoscopy screening, but the additional preventive effect was less than what was achieved by introducing sigmoidoscopy screening where no screening existed. The results probably represent the upper limit of what may be achieved with colonoscopy screening compared with sigmoidoscopy screening.
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Affiliation(s)
- Frederik E. Juul
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Amanda J. Cross
- Cancer Screening & Prevention Research Group, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Robert E. Schoen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carlo Senore
- University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Paul F. Pinsky
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Eric A. Miller
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Nereo Segnan
- University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Kate Wooldrage
- Cancer Screening & Prevention Research Group, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Paulina Wieszczy-Szczepanik
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Paola Armaroli
- University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Kjetil K. Garborg
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Hans-Olov Adami
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Geir Hoff
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Research and Development, Telemark Hospital Trust, Skien, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mette Kalager
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Øyvind Holme
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
- Department of Medicine, Sorlandet Hospital Health Trust, Kristiansand, Norway
| | - Magnus Løberg
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
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12
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Brenner H, Heisser T, Cardoso R, Hoffmeister M. Reduction in colorectal cancer incidence by screening endoscopy. Nat Rev Gastroenterol Hepatol 2024; 21:125-133. [PMID: 37794234 DOI: 10.1038/s41575-023-00847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/06/2023]
Abstract
Colorectal cancer (CRC) incidence rates decreased by up to 50% in older age groups in the USA in the era of the widespread uptake of screening colonoscopy, despite adverse trends in CRC risk factors and increasing CRC incidence at younger ages. However, reported first results from a randomized trial, the NordICC study, suggested rather modest effects of screening colonoscopy. As outlined in this Perspective, the apparent discrepancy between real-world and trial evidence could be explained by strong attenuation of effect estimates from screening endoscopy trials by several factors, including limited screening adherence, widespread uptake of colonoscopy outside the screening offers and the inclusion of prevalent, non-preventable CRC cases in reported numbers of incident cases. Alternative interpretations of screening endoscopy trial results accounting for prevalence bias are in line with trends in CRC incidence reduction in countries offering CRC screening, and should encourage more widespread implementation and uptake of effective CRC screening.
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Affiliation(s)
- Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumour Diseases (NCT), Heidelberg, Germany.
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rafael Cardoso
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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13
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Angrist JD, Hull P. Instrumental variables methods reconcile intention-to-screen effects across pragmatic cancer screening trials. Proc Natl Acad Sci U S A 2023; 120:e2311556120. [PMID: 38100416 PMCID: PMC10742387 DOI: 10.1073/pnas.2311556120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/03/2023] [Indexed: 12/17/2023] Open
Abstract
Pragmatic cancer screening trials mimic real-world scenarios in which patients and doctors are the ultimate arbiters of treatment. Intention-to-screen (ITS) analyses of such trials maintain randomization-based apples-to-apples comparisons, but differential adherence (the failure of subjects assigned to screening to get screened) makes ITS effects hard to compare across trials and sites. We show how instrumental variables (IV) methods address the nonadherence challenge in a comparison of estimates from 17 sites in five randomized trials measuring screening effects on colorectal cancer incidence. While adherence rates and ITS estimates vary widely across and within trials, IV estimates of per-protocol screening effects are remarkably consistent. An application of simple IV tools, including graphical analysis and formal statistical tests, shows how differential adherence explains variation in ITS impact. Screening compliers are also shown to have demographic characteristics similar to those of the full trial study sample. These findings argue for the clinical relevance of IV estimates of cancer screening effects.
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Affiliation(s)
- Joshua D. Angrist
- Department of Economics and National Bureau of Economic Research, Massachusetts Institute of Technology, Cambridge, MA02142
| | - Peter Hull
- Department of Economics and National Bureau of Economic Research, Brown University, Providence, RI02912
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14
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Wang X, Cao L, Song X, Zhu G, Ni B, Ma X, Li J. Is flexible sigmoidoscopy screening associated with reducing colorectal cancer incidence and mortality? a meta-analysis and systematic review. Front Oncol 2023; 13:1288086. [PMID: 38162502 PMCID: PMC10757863 DOI: 10.3389/fonc.2023.1288086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024] Open
Abstract
Background The question of whether flexible sigmoidoscopy (FS) for colorectal cancer (CRC) affects incidence or mortality remains unclear. In this study, we conducted a meta-analysis and systematic review to explore this issue. Methods A systematic search of PubMed, EMBASE, and ClinicalTrials.gov was performed for cohort studies (CS), case-control studies, and randomized controlled trials (RCTs) of people who underwent FS and reported mortality or incidence of CRC until 11 December 2022. Relative risk (RR) was applied as an estimate of the effect of interest. To combine the RRs and 95% confidence intervals, a random-effects model was used. The quality of the included studies and evidence was assessed by the Newcastle-Ottawa quality assessment scale, the Jadad scale, and the "Grading of Recommendations Assessment, Development and Evaluation System." Results There were a total of six RCTs and one CS, comprising 702,275 individuals. FS was found to be associated with a 26% RR reduction in CRC incidence (RR, 0.74; 95% CI, 0.66-0.84) and a 30% RR reduction in CRC mortality (RR, 0.70; 95% CI, 0.58-0.85). In the incidence subgroup analysis, FS significantly reduced the incidence of CRC compared with non-screening, usual care, and fecal immunochemical testing. Significance was also shown in men, women, distal site, stages III-IV, ages 55-59, and age over 60. In terms of the mortality subgroup analysis, the results were roughly the same as those of incidence. Conclusion According to this study, FS might reduce the incidence and mortality of CRC. To confirm this finding, further prospective clinical studies should be conducted based on a larger-scale population. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023388925.
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Affiliation(s)
- Xinmiao Wang
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Luchang Cao
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaotong Song
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guanghui Zhu
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Baoyi Ni
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinyi Ma
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Li
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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15
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Brenner H, Heisser T, Cardoso R, Hoffmeister M. When gold standards are not so golden: prevalence bias in randomized trials on endoscopic colorectal cancer screening. Eur J Epidemiol 2023; 38:933-937. [PMID: 37530938 PMCID: PMC10501935 DOI: 10.1007/s10654-023-01031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
Randomized trials on the effectiveness of screening endoscopy in reducing colorectal cancer (CRC) risk have reported statistically significant, but rather modest reduction of CRC risk by the screening offer. However, risk estimates in these trials included substantial proportions of prevalent CRC cases which were early detected, but could not possibly have been prevented by screening. Thereby, a key principle of randomized prevention trials is violated that only "at risk" persons who do not yet have the disease one aims to prevent should be included in measures of preventive effects. Using recently published data from the Nordic-European Initiative on Colorectal Cancer (NordICC) trial as an example, we illustrate that approaches aimed to account for "prevalence bias" lead to effect estimates that are substantially larger than those reported in the trial and more in line with results from observational studies and real life settings. More rigorous methodological work is needed to develop effective and user-friendly tools to prevent or adjust for prevalence bias in future screening studies.
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Affiliation(s)
- Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), INF 581, Heidelberg, 69120, Germany.
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumour Diseases (NCT), Heidelberg, Germany.
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), INF 581, Heidelberg, 69120, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Rafael Cardoso
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), INF 581, Heidelberg, 69120, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), INF 581, Heidelberg, 69120, Germany
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16
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Zhang C, Liu L, Li J, Lv Y, Wu D, Xu S, Cao C, Zhao L, Liu Y, Ma X, Yang X, Du B. Effect of flexible sigmoidoscopy-based screening on colorectal cancer incidence and mortality: an updated systematic review and meta-analysis of randomized controlled trials. Expert Rev Anticancer Ther 2023; 23:1217-1227. [PMID: 37542427 DOI: 10.1080/14737140.2023.2245564] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Our objective was to estimate the effect of flexible sigmoidoscopy (FS)-based screening on colorectal cancer (CRC) incidence and mortality by conducting an updated meta-analysis of randomized controlled trials (RCTs). METHODS PubMed, Web of Science, Embase, and Cochrane Library searched for RCTs from database inception to December 2022. The methodological quality of the RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. RevMan 5.4 was used for this meta-analysis. RESULTS Four RCTs involving 457, 871 patients were included. This meta-analysis revealed that FS-based screening was associated with a 20% relative risk reduction in CRC incidence [RR = 0.80; 95% CI (0.75, 0.86); P < 0.00001], and a 24% reduction in CRC mortality [RR = 0.76; 95% CI (0.70, 0.82); P < 0.00001]. In addition, this meta-analysis revealed that FS-based screening reduced the incidence[RR = 0.68; 95% CI (0.60, 0.77); P < 0.00001] and mortality[RR = 0.64; 95% CI (0.49, 0.83); P = 0.0007] of distal CRC, but had no significant effect on proximal colon cancer. CONCLUSION FS-based screening appeared to be effective in reducing distal CRC incidence and mortality in patients at average risk compared to no intervention, but had no significant effect on proximal colon cancer.
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Affiliation(s)
- Chengren Zhang
- Department of Anorectal Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou, Gansu, China
| | - Lili Liu
- Department of Anorectal Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Jingjing Li
- Department of Anorectal Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou, Gansu, China
| | - Yaochun Lv
- Department of Anorectal Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou, Gansu, China
| | - Dewang Wu
- Department of Anorectal Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou, Gansu, China
| | - Shiyun Xu
- Department of Anorectal Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou, Gansu, China
| | - Cong Cao
- Department of Anorectal Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou, Gansu, China
| | - Lixia Zhao
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou, Gansu, China
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Yijun Liu
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou, Gansu, China
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Xiaolong Ma
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou, Gansu, China
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Xiongfei Yang
- Department of Anorectal Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou, Gansu, China
| | - Binbin Du
- Department of Anorectal Surgery, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
- General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou, Gansu, China
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17
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Zheng S, Schrijvers JJA, Greuter MJW, Kats-Ugurlu G, Lu W, de Bock GH. Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15071948. [PMID: 37046609 PMCID: PMC10093633 DOI: 10.3390/cancers15071948] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: The aim of this study was to pool and compare all-cause and colorectal cancer (CRC) specific mortality reduction of CRC screening in randomized control trials (RCTs) and simulation models, and to determine factors that influence screening effectiveness. (2) Methods: PubMed, Embase, Web of Science and Cochrane library were searched for eligible studies. Multi-use simulation models or RCTs that compared the mortality of CRC screening with no screening in general population were included. CRC-specific and all-cause mortality rate ratios and 95% confidence intervals were calculated by a bivariate random model. (3) Results: 10 RCTs and 47 model studies were retrieved. The pooled CRC-specific mortality rate ratios in RCTs were 0.88 (0.80, 0.96) and 0.76 (0.68, 0.84) for guaiac-based fecal occult blood tests (gFOBT) and single flexible sigmoidoscopy (FS) screening, respectively. For the model studies, the rate ratios were 0.45 (0.39, 0.51) for biennial fecal immunochemical tests (FIT), 0.31 (0.28, 0.34) for biennial gFOBT, 0.61 (0.53, 0.72) for single FS, 0.27 (0.21, 0.35) for 10-yearly colonoscopy, and 0.35 (0.29, 0.42) for 5-yearly FS. The CRC-specific mortality reduction of gFOBT increased with higher adherence in both studies (RCT: 0.78 (0.68, 0.89) vs. 0.92 (0.87, 0.98), model: 0.30 (0.28, 0.33) vs. 0.92 (0.51, 1.63)). Model studies showed a 0.62-1.1% all-cause mortality reduction with single FS screening. (4) Conclusions: Based on RCTs and model studies, biennial FIT/gFOBT, single and 5-yearly FS, and 10-yearly colonoscopy screening significantly reduces CRC-specific mortality. The model estimates are much higher than in RCTs, because the simulated biennial gFOBT assumes higher adherence. The effectiveness of screening increases at younger screening initiation ages and higher adherences.
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Affiliation(s)
- Senshuang Zheng
- Medical Center Groningen, Department of Epidemiology, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Jelle J A Schrijvers
- Medical Center Groningen, Department of Epidemiology, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Marcel J W Greuter
- Medical Center Groningen, Department of Radiology, University of Groningen, 9700 RB Groningen, The Netherlands
- Robotics and Mechatronics (RaM) Group, Technical Medical Centre, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, 7522 NH Enschede, The Netherlands
| | - Gürsah Kats-Ugurlu
- Medical Center Groningen, Department of Pathology, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin 300070, China
| | - Geertruida H de Bock
- Medical Center Groningen, Department of Epidemiology, University of Groningen, 9700 RB Groningen, The Netherlands
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Schuldt K, Trocchi P, Stang A. Skin Cancer Screening and Medical Treatment Intensity in Patients with Malignant Melanoma and Non-Melanocytic Skin Cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:33-39. [PMID: 36471642 PMCID: PMC10043458 DOI: 10.3238/arztebl.m2022.0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 02/28/2022] [Accepted: 10/27/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND This cohort study concerns the effect of skin cancer screening (SCS) on medical treatment intensity in patients with skin cancer. METHODS Routine data from persons aged 35 to 99 who were insured by the AOK health insurance company were used to identify persons who received a diagnosis of malignant melanoma or a non-melanocytic skin cancer in 2014 or 2015, either through skin cancer screening or without screening. These persons were included in cohort studies. The routine data contained no information on tumor stages or grading. Tumor-associated rates of hospital admission, contact with physicians in outpatient practice, and intensity of surgical treatment were determined; rate ratios (RR) and their 95% confidence intervals (CI) were estimated. RESULTS The cohort studies included 13 633 patients with melanoma (6480 with SCS and 7153 without) and 118 168 patients with non-melanocytic skin cancer (43 308 with screening and 74 860 without). Patients whose melanomas had been detected by screening had a lower medical treatment intensity than unscreened patients (intensity of tumor-associated surgical treatment (RR = 0.79, 95% CI [0.74; 0.85]), hospital contact rate (RR = 0.44, 95% CI: [0.38; 0.50]), contact with physicians in outpatient practice (RR = 0.79, 95% CI: [0.73; 0.85]). Among patients with non-melanocytic skin cancer, the screened patients displayed a lower hospital contact rate (RR = 0.52, 95% CI: [0.49; 0.56]), a higher contact rate in the outpatient sector (RR = 1.11, 95% CI: [1.08; 1.13]), and no difference in surgical treatment intensity (RR = 0.98, 95% CI: [0.96; 1.00]). CONCLUSION SCS is associated with lower medical treatment intensity in the first 12 months after diagnosis in patients with melanoma. Among patients with non-melanocytic skin cancer, those who had been screened had lower hospital contact rates, but there was no observed lowering of other rates reflecting treatment intensity.
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Affiliation(s)
- Katrin Schuldt
- Institute of Medical Informatics, Biometry and Epidemiology University Hospital of Essen; Department of Epidemiology, Boston University School of Public Health, Boston, USA; North Rhine-Westphalia State Cancer Registry, Bochum
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Juul FE, Cross AJ, Schoen RE, Senore C, Pinsky P, Miller E, Segnan N, Wooldrage K, Wieszczy-Szczepanik P, Armaroli P, Garborg KK, Adami HO, Hoff G, Kalager M, Bretthauer M, Løberg M, Holme Ø. 15-Year Benefits of Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality : A Pooled Analysis of Randomized Trials. Ann Intern Med 2022; 175:1525-1533. [PMID: 36215714 DOI: 10.7326/m22-0835] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The effectiveness of screening for colorectal cancer (CRC) by sex and age in randomized trials is uncertain. OBJECTIVE To evaluate the 15-year effect of sigmoidoscopy screening on CRC incidence and mortality. DESIGN Pooled analysis of 4 large-scale randomized trials of sigmoidoscopy screening. SETTING Norway, the United States, the United Kingdom, and Italy. PARTICIPANTS Women and men aged 55 to 64 years at enrollment. INTERVENTION Sigmoidoscopy screening. MEASUREMENTS Primary end points were cumulative incidence rate ratio (IRR) and mortality rate ratio (MRR) and rate differences after 15 years of follow-up comparing screening versus usual care in intention-to-treat analyses. Stratified analyses were done by sex, cancer site, and age at screening. RESULTS Analyses comprised 274 952 persons (50.7% women), 137 493 in the screening and 137 459 in the usual care group. Screening attendance was 58% to 84%. After 15 years, the rate difference for CRC incidence was 0.51 cases (95% CI, 0.40 to 0.63 cases) per 100 persons and the IRR was 0.79 (CI, 0.75 to 0.83). The rate difference for CRC mortality was 0.13 deaths (CI, 0.07 to 0.19 deaths) per 100 persons, and the MRR was 0.80 (CI, 0.72 to 0.88). Women had less benefit from screening than men for CRC incidence (IRR for women, 0.84 [CI, 0.77 to 0.91]; IRR for men, 0.75 [CI, 0.70 to 0.81]; P = 0.032 for difference) and mortality (MRR for women, 0.91 [CI, 0.77 to 1.17]; MRR for men, 0.73 [CI, 0.64 to 0.83]; P = 0.025 for difference). There was no statistically significant difference in screening effect between persons aged 55 to 59 years and those aged 60 to 64 years. LIMITATION Data from the U.K. trial were less granular because of privacy regulations. CONCLUSION This pooled analysis of all large randomized trials of sigmoidoscopy screening demonstrates a significant and sustained effect of sigmoidoscopy on CRC incidence and mortality for 15 years. PRIMARY FUNDING SOURCE Health Fund of South-East Norway.
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Affiliation(s)
- Frederik E Juul
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, and Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway (F.E.J., K.K.G., M.K., M.B., M.L.)
| | - Amanda J Cross
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom (A.J.C., K.W.)
| | - Robert E Schoen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (R.E.S.)
| | - Carlo Senore
- University Hospital Città della Salute e della Scienza, Turin, Italy (C.S., N.S., P.A.)
| | - Paul Pinsky
- National Cancer Institute, Division of Cancer Prevention, Rockville, Maryland (P.P., E.M.)
| | - Eric Miller
- National Cancer Institute, Division of Cancer Prevention, Rockville, Maryland (P.P., E.M.)
| | - Nereo Segnan
- University Hospital Città della Salute e della Scienza, Turin, Italy (C.S., N.S., P.A.)
| | - Kate Wooldrage
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom (A.J.C., K.W.)
| | - Paulina Wieszczy-Szczepanik
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, and Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway, and Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland (P.W.)
| | - Paola Armaroli
- University Hospital Città della Salute e della Scienza, Turin, Italy (C.S., N.S., P.A.)
| | - Kjetil K Garborg
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, and Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway (F.E.J., K.K.G., M.K., M.B., M.L.)
| | - Hans-Olov Adami
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, and Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (H.O.A.)
| | - Geir Hoff
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Department of Research and Development, Telemark Hospital Trust, Skien, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway (G.H.)
| | - Mette Kalager
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, and Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway (F.E.J., K.K.G., M.K., M.B., M.L.)
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, and Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway (F.E.J., K.K.G., M.K., M.B., M.L.)
| | - Magnus Løberg
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, and Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway (F.E.J., K.K.G., M.K., M.B., M.L.)
| | - Øyvind Holme
- Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, and Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway, and Department of Medicine, Sørlandet Hospital Health Trust, Kristiansand, Norway (Ø.H.)
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20
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Sung JJY, Chiu HM, Lieberman D, Kuipers EJ, Rutter MD, Macrae F, Yeoh KG, Ang TL, Chong VH, John S, Li J, Wu K, Ng SSM, Makharia GK, Abdullah M, Kobayashi N, Sekiguchi M, Byeon JS, Kim HS, Parry S, Cabral-Prodigalidad PAI, Wu DC, Khomvilai S, Lui RN, Wong S, Lin YM, Dekker E. Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance. Gut 2022; 71:2152-2166. [PMID: 36002247 DOI: 10.1136/gutjnl-2022-327377] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 12/09/2022]
Abstract
The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.
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Affiliation(s)
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | - Finlay Macrae
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Vui Heng Chong
- Raja Isteri Pengiran Anak Saleha Hospital, Brunei, Brunei Darussalam
| | - Sneha John
- Digestive Health, Endoscopy, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jingnan Li
- Peking Union Medical College Hospital, Beijing, China
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Simon S M Ng
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Murdani Abdullah
- Division of Gastroenterology, Pancreatibiliar and Digestive Endoscopy. Department of Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia.,Human Cancer Research Center. IMERI. Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nozomu Kobayashi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Masau Sekiguchi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Jeong-Sik Byeon
- University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Hyun-Soo Kim
- Yonsei University, Seoul, Korea (the Republic of)
| | - Susan Parry
- National Bowel Screening Programme, New Zealand Ministry of Health, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | | | | | | | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny Wong
- Lee Kong Chian School of Medicine, Singapore
| | - Yu-Min Lin
- Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - E Dekker
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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21
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Bretthauer M, Løberg M, Wieszczy P, Kalager M, Emilsson L, Garborg K, Rupinski M, Dekker E, Spaander M, Bugajski M, Holme Ø, Zauber AG, Pilonis ND, Mroz A, Kuipers EJ, Shi J, Hernán MA, Adami HO, Regula J, Hoff G, Kaminski MF. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. N Engl J Med 2022; 387:1547-1556. [PMID: 36214590 DOI: 10.1056/nejmoa2208375] [Citation(s) in RCA: 250] [Impact Index Per Article: 125.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear. METHODS We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio either to receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause. RESULTS Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden - 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93). The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95% CI, 270 to 1429). The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04). CONCLUSIONS In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening. (Funded by the Research Council of Norway and others; NordICC ClinicalTrials.gov number, NCT00883792.).
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Affiliation(s)
- Michael Bretthauer
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Magnus Løberg
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Paulina Wieszczy
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Mette Kalager
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Louise Emilsson
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Kjetil Garborg
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Maciej Rupinski
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Evelien Dekker
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Manon Spaander
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Marek Bugajski
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Øyvind Holme
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Ann G Zauber
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Nastazja D Pilonis
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Andrzej Mroz
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Ernst J Kuipers
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Joy Shi
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Miguel A Hernán
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Hans-Olov Adami
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Jaroslaw Regula
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Geir Hoff
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Michal F Kaminski
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
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Cardoso R, Guo F, Heisser T, De Schutter H, Van Damme N, Nilbert MC, Christensen J, Bouvier AM, Bouvier V, Launoy G, Woronoff AS, Cariou M, Robaszkiewicz M, Delafosse P, Poncet F, Walsh PM, Senore C, Rosso S, Lemmens VE, Elferink MA, Tomšič S, Žagar T, Marques ALDM, Marcos-Gragera R, Puigdemont M, Galceran J, Carulla M, Sánchez-Gil A, Chirlaque MD, Hoffmeister M, Brenner H. Overall and stage-specific survival of patients with screen-detected colorectal cancer in European countries: A population-based study in 9 countries. Lancet Reg Health Eur 2022; 21:100458. [PMID: 35832063 PMCID: PMC9272368 DOI: 10.1016/j.lanepe.2022.100458] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background An increasing proportion of colorectal cancers (CRCs) are detected through screening due to the availability of organised population-based programmes. We aimed to analyse survival probabilities of patients with screen-detected CRC in European countries. Methods Data from CRC patients were obtained from 16 population-based cancer registries in nine European countries. We included patients with cancer diagnosed from the year organised CRC screening programmes were introduced until the most recent year with available data at the time of analysis, whose ages at diagnosis fell into the age groups targeted by screening. Patients were followed up with regards to vital status until 2016-2020 across the various countries. Overall and CRC-specific survival were analysed by mode of detection and stage at diagnosis for all countries combined and for each country separately using the Kaplan-Meier method. Findings We included data from 228 134 patients, of whom 134 597 (aged 60-69 years at diagnosis targeted by screening in all countries) were considered in analyses for all countries combined. 22·3% (38 080/134 597) of patients had cancer detected through screening. Most screen-detected cancers were found at stages I-II (65·6% [12 772/19 469 included in stage-specific analyses]), while the majority of non-screen-detected cancers were found at stages III-IV (56·4% [31 882/56 543 included in stage-specific analyses]). Five-year overall and CRC-specific survival rates for patients with screen-detected cancer were 83·4% (95% CI 82·9-83·9) and 89·2% (88·8-89·7), respectively; for patients with non-screen-detected cancer, they were much lower (57·5% [57·2-57·8] and 65·7% [65·4-66·1], respectively). The favourable survival of patients with screen-detected cancer was also seen within each stage – five-year overall survival rates for patients with screen-detected stage I, II, III, and IV cancers were 92.4% (95% CI 91·6-93·1), 87·9% (86·6-89·1), 80·7% (79·3-82·0), and 32·3 (29·4-35·2), respectively. These patterns were also consistently seen for each individual country. Interpretation Patients with cancer diagnosed at screening have a very favourable prognosis. In the rare case of detection of advanced stage cancer, survival probabilities are still much higher than those commonly reported for all patients regardless of mode of detection. Although these results cannot be taken to quantify screening effects, they provide useful and encouraging information for patients with screen-detected CRC and their physicians. Funding This study was supported in part by grants from the German Federal Ministry of Education and Research and the German Cancer Aid.
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Affiliation(s)
- Rafael Cardoso
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Feng Guo
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Heisser
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Mef Christina Nilbert
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne-Marie Bouvier
- Digestive cancer registry of Burgundy, University Hospital of Dijon, French Network of Cancer Registries (FRANCIM), Inserm, U1231 Dijon, France
| | - Véronique Bouvier
- Digestive Tumors Registry of Calvados, University Hospital of Caen, U1086 INSERM UCN - ANTICIPE, French Network of Cancer Registries (FRANCIM), France
| | - Guy Launoy
- Normandie Univ, UniCaen, Inserm, Anticipe, 14000 Caen, France
- University Hospital of Caen, Caen, France
| | | | - Mélanie Cariou
- Digestive Tumors Registry of Finistère, CHRU Morvan, French Network of Cancer Registries (FRANCIM), Brest, France
| | - Michel Robaszkiewicz
- Digestive Tumors Registry of Finistère, CHRU Morvan, French Network of Cancer Registries (FRANCIM), Brest, France
| | - Patricia Delafosse
- Cancer Registry of Isère, French Network of Cancer Registries (FRANCIM), Grenoble, France
| | - Florence Poncet
- Cancer Registry of Isère, French Network of Cancer Registries (FRANCIM), Grenoble, France
| | | | - Carlo Senore
- University Hospital ‘Città della Salute e della Scienza’, SSD Epidemiologia e screening – CPO, Turin, Italy
| | | | - Valery E.P.P. Lemmens
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marloes A.G. Elferink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | - Sonja Tomšič
- Slovenian Cancer Registry, Institute of Oncology, Ljubljana, Slovenia
| | - Tina Žagar
- Slovenian Cancer Registry, Institute of Oncology, Ljubljana, Slovenia
| | | | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Salt, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid, Spain
| | - Montse Puigdemont
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Jaume Galceran
- Tarragona Cancer Registry, Epidemiology and Prevention Cancer Service, Hospital Universitari Sant Joan de Reus, Pere Virgili Health Research Institute (IISPV), Reus, Spain
| | - Marià Carulla
- Tarragona Cancer Registry, Epidemiology and Prevention Cancer Service, Hospital Universitari Sant Joan de Reus, Pere Virgili Health Research Institute (IISPV), Reus, Spain
| | - Antonia Sánchez-Gil
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - María-Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Corresponding author at: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
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23
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Cardoso R, Guo F, Heisser T, De Schutter H, Van Damme N, Nilbert MC, Tybjerg AJ, Bouvier AM, Bouvier V, Launoy G, Woronoff AS, Cariou M, Robaszkiewicz M, Delafosse P, Poncet F, Walsh PM, Senore C, Rosso S, Lemmens VEPP, Elferink MAG, Tomšič S, Žagar T, Lopez de Munain Marques A, Marcos-Gragera R, Puigdemont M, Galceran J, Carulla M, Sánchez-Gil A, Chirlaque MD, Hoffmeister M, Brenner H. Proportion and stage distribution of screen-detected and non-screen-detected colorectal cancer in nine European countries: an international, population-based study. Lancet Gastroenterol Hepatol 2022; 7:711-723. [PMID: 35561739 DOI: 10.1016/s2468-1253(22)00084-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The effects of recently implemented colorectal cancer screening programmes in Europe on colorectal cancer mortality will take several years to be fully known. We aimed to analyse the characteristics and parameters of screening programmes, proportions of colorectal cancers detected through screening, and stage distribution in screen-detected and non-screen-detected colorectal cancers to provide a timely assessment of the potential effects of screening programmes in several European countries. METHODS We conducted this population-based study in nine European countries for which data on mode of detection were available (Belgium, Denmark, England, France, Italy, Ireland, the Netherlands, Slovenia, and Spain). Data from 16 population-based cancer registries were included. Patients were included if they were diagnosed with colorectal cancer from the year that organised colorectal cancer screening programmes were implemented in each country until the latest year with available data at the time of analysis, and if their age at diagnosis fell within the age groups targeted by the programmes. Data collected included sex, age at diagnosis, date of diagnosis, topography, morphology, clinical and pathological TNM information based on the edition in place at time of diagnosis, and mode of detection (ie, screen detected or non-screen detected). If stage information was not available, patients were not included in stage-specific analyses. The primary outcome was proportion and stage distribution of screen-detected versus non-screen detected colorectal cancers. FINDINGS 228 667 colorectal cancer cases were included in the analyses. Proportions of screen-detected cancers varied widely across countries and regions. The highest proportions (40-60%) were found in Slovenia and the Basque Country in Spain, where FIT-based programmes were fully rolled out, and participation rates were higher than 50%. A similar proportion of screen-detected cancers was also found for the Netherlands in 2015, where participation was over 70%, even though the programme had not yet been fully rolled out to all age groups. In most other countries and regions, proportions of screen-detected cancers were below 30%. Compared with non-screen-detected cancers, screen-detected cancers were much more often found in the distal colon (range 34·5-51·1% screen detected vs 26·4-35·7% non-screen detected) and less often in the proximal colon (19·5-29·9% screen detected vs 24·9-32·8% non-screen detected) p≤0·02 for each country, more often at stage I (35·7-52·7% screen detected vs 13·2-24·9% non-screen detected), and less often at stage IV (5·8-12·5% screen detected vs 22·5-31·9% non-screen detected) p<0·0001 for each country. INTERPRETATION The proportion of colorectal cancer cases detected by screening varied widely between countries. However, in all countries, screen-detected cancers had a more favourable stage distribution than cancers detected otherwise. There is still much need and scope for improving early detection of cancer across all segments of the colorectum, and particularly in the proximal colon and rectum. FUNDING Deutsche Krebshilfe.
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Affiliation(s)
- Rafael Cardoso
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases, Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Feng Guo
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
| | - Thomas Heisser
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
| | | | | | - Mef Christina Nilbert
- Danish Cancer Society Research Center, Copenhagen, Denmark; Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, Dijon, France, INSERM U1231, University Hospital of Dijon, French Network of Cancer Registries (FRANCIM), Dijon, France
| | - Véronique Bouvier
- Digestive Tumors Registry of Calvados, University Hospital of Caen, U1086 INSERM UCN - ANTICIPE, FRANCIM, Caen, France
| | - Guy Launoy
- Normandie University, UniCaen, INSERM ANTICIPE, Caen, France; University Hospital of Caen, Caen, France
| | - Anne-Sophie Woronoff
- Cancer Registry of Doubs, Centre Hospitalier Régional Universitaire Besançon (CHRU) Besançon, France
| | - Mélanie Cariou
- Digestive Tumors Registry of Finistère, CHRU Morvan, FRANCIM, Brest, France
| | | | | | | | | | | | - Stefano Rosso
- Piedmont Cancer Registry, University Hospital 'Città della Salute e della Scienza', Turin, Italy
| | - Valery E P P Lemmens
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marloes A G Elferink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Sonja Tomšič
- Slovenian Cancer Registry, Institute of Oncology, Ljubljana, Slovenia
| | - Tina Žagar
- Slovenian Cancer Registry, Institute of Oncology, Ljubljana, Slovenia
| | | | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute, Salt, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública), Madrid, Spain
| | - Montse Puigdemont
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute, Salt, Spain
| | - Jaume Galceran
- Tarragona Cancer Registry, Epidemiology and Prevention Cancer Service, Hospital Universitari Sant Joan de Reus, Pere Virgili Health Research Institute (IISPV), Reus, Spain
| | - Marià Carulla
- Tarragona Cancer Registry, Epidemiology and Prevention Cancer Service, Hospital Universitari Sant Joan de Reus, Pere Virgili Health Research Institute (IISPV), Reus, Spain
| | - Antonia Sánchez-Gil
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - María-Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública), Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain; Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
| | - Hermann Brenner
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases, Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany; German Cancer Consortium, DKFZ, Heidelberg, Germany.
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