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    Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study

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    Authors
    Doubeni, Chyke A.
    Weinmann, Sheila
    Adams, Kenneth
    Kamineni, Aruna
    Buist, Diana S. M.
    Ash, Arlene S.
    Rutter, Carolyn M.
    Doria-Rose, V. Paul
    Corley, Douglas A.
    Greenlee, Robert T.
    Chubak, Jessica
    Williams, Andrew E.
    Kroll-Desrosiers, Aimee R.
    Johnson, Eric
    Webster, Joseph
    Richert-Boe, Kathryn
    Levin, Theodore R.
    Fletcher, Robert H.
    Weiss, Noel S.
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    UMass Chan Affiliations
    Meyers Primary Care Institute
    Department of Family Medicine and Community Health
    Department of Pathology
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2013-03-05
    Keywords
    Colonoscopy
    Colorectal Neoplasms
    Early Detection of Cancer
    Mass Screening
    Community Health and Preventive Medicine
    Epidemiology
    Neoplasms
    Oncology
    
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    Link to Full Text
    http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23460054/
    Abstract
    BACKGROUND: The effectiveness of screening colonoscopy in average-risk adults is uncertain, particularly for right colon cancer. OBJECTIVE: To examine the association between screening colonoscopy and risk for incident late-stage colorectal cancer (CRC). DESIGN: Nested case-control study. SETTING: Four U.S. health plans. PATIENTS: 1039 average-risk adults enrolled for at least 5 years in one of the health plans. Case patients were aged 55 to 85 years on their diagnosis date (reference date) of stage IIB or higher (late-stage) CRC during 2006 to 2008. One or 2 control patients were selected for each case patient, matched on birth year, sex, health plan, and prior enrollment duration. MEASUREMENTS: Receipt of CRC screening 3 months to 10 years before the reference date, ascertained through medical record audits. Case patients and control patients were compared on receipt of screening colonoscopy or sigmoidoscopy by using conditional logistic regression that accounted for health history, socioeconomic status, and other screening exposures. RESULTS: In analyses restricted to 471 eligible case patients and their 509 matched control patients, 13 case patients (2.8%) and 46 control patients (9.0%) had undergone screening colonoscopy, which corresponded to an adjusted odds ratio (AOR) of 0.29 (95% CI, 0.15 to 0.58) for any late-stage CRC, 0.36 (CI, 0.16 to 0.80) for right colon cancer, and 0.26 (CI, 0.06 to 1.11; P = 0.069) for left colon/rectum cancer. Ninety-two case patients (19.5%) and 173 control patients (34.0%) had screening sigmoidoscopy, corresponding to an AOR of 0.50 (CI, 0.36 to 0.70) overall, 0.79 (CI, 0.51 to 1.23) for right colon late-stage cancer, and 0.26 (CI, 0.14 to 0.48) for left colon cancer. LIMITATION: The small number of screening colonoscopies affected the precision of the estimates. CONCLUSION: Screening with colonoscopy in average-risk persons was associated with reduced risk for diagnosis of incident late-stage CRC, including right-sided colon cancer. For sigmoidoscopy, this association was seen for left CRC, but the association for right colon late-stage cancer was not statistically significant. PRIMARY FUNDING SOURCE: National Cancer Institute of the National Institutes of Health.
    Source
    Ann Intern Med. 2013;158(5_Part_1):312-320. doi:10.7326/0003-4819-158-5-201303050-00003. Link to article on publisher's site
    DOI
    10.7326/0003-4819-158-5-201303050-00003
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/46618
    PubMed ID
    23460054
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.7326/0003-4819-158-5-201303050-00003
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