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6 January 2009 | Volume 150 Issue 1 | Pages 1-8
Background: Colonoscopy is advocated for screening and prevention of colorectal cancer (CRC), but randomized trials supporting the benefit of this practice are not available.
Objective: To evaluate the association between colonoscopy and CRC deaths.
Design: Population-based, case–control study.
Setting: Ontario, Canada.
Patients: Persons age 52 to 90 years who received a CRC diagnosis from January 1996 to December 2001 and died of CRC by December 2003. Five controls matched by age, sex, geographic location, and socioeconomic status were randomly selected for each case patient.
Measurements: Administrative claims data were used to detect exposure to any colonoscopy and complete colonoscopy (to the cecum) from January 1992 to an index date 6 months before diagnosis in each case patient and the same assigned date in matched controls. Exposures in case patients and controls were compared by using conditional logistic regression to control for comorbid conditions. Secondary analyses were done to see whether associations differed by site of primary CRC, age, or sex.
Results: 10 292 case patients and 51 460 controls were identified; 719 case patients (7.0%) and 5031 controls (9.8%) had undergone colonoscopy. Compared with controls, case patients were less likely to have undergone any attempted colonoscopy (adjusted conditional odds ratio [OR], 0.69 [95% CI, 0.63 to 0.74; P < 0.001]) or complete colonoscopy (adjusted conditional OR, 0.63 [CI, 0.57 to 0.69; P < 0.001]). Complete colonoscopy was strongly associated with fewer deaths from left-sided CRC (adjusted conditional OR, 0.33 [CI, 0.28 to 0.39]) but not from right-sided CRC (adjusted conditional OR, 0.99 [CI, 0.86 to 1.14]).
Limitation: Screening could not be differentiated from diagnostic procedures.
Conclusion: In usual practice, colonoscopy is associated with fewer deaths from CRC. This association is primarily limited to deaths from cancer developing in the left side of the colon.
Funding: Canadian Institutes of Health Research and American Society of Clinical Oncology.
Editors' Notes
Context
Contribution
Caution
Implication
—The Editors
Author and Article Information
From Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network and University of Toronto; Institute for Clinical Evaluative Sciences; and Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Acknowledgment: The authors thank Dr. Frank Giardiello for helpful suggestions.
Grant Support: By a Canadian Institutes of Health Research Pilot Project Grant, a Canadian Institutes of Health New Investigator Award (Dr. Baxter), and an American Society of Clinical Oncology Career Development Award. This study was supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by the Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.
Potential Financial Conflicts of Interest: None disclosed.
Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Baxter (e-mail, baxtern{at}smh.toronto.on.ca). Data set: Not available.
Requests for Single Reprints: Nancy N. Baxter, MD, PhD, Division of General Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street 16CC-40, Toronto, Ontario M5B 1W8, Canada; e-mail, baxtern{at}smh.toronto.on.ca.
Current Author Addresses: Dr. Baxter: Division of General Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street 16CC-40, Toronto, Ontario M5B 1W8, Canada.
Drs. Goldwasser and Paszat and Mr. Saskin: Institute for Clinical Evaluative Sciences, G1-06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Dr. Urbach: University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
Dr. Rabeneck: Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room T2 025, Toronto, Ontario M4N 3M5, Canada.
Author Contributions: Conception and design: N.N. Baxter, M.A. Goldwasser, L.F. Paszat, D.R. Urbach, L. Rabeneck.
Analysis and interpretation of the data: N.N. Baxter, M.A. Goldwasser, L.F. Paszat, R. Saskin, D.R. Urbach, L. Rabeneck.
Drafting of the article: N.N. Baxter, R. Saskin.
Critical revision of the article for important intellectual content: N.N. Baxter.
Final approval of the article: N.N. Baxter, M.A. Goldwasser, L.F. Paszat, D.R. Urbach, L. Rabeneck.
Statistical expertise: N.N. Baxter.
Obtaining of funding: N.N. Baxter.
Collection and assembly of data: R. Saskin. ARTICLE
Association of Colonoscopy and Death From Colorectal Cancer
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