TY - JOUR
T1 - Risk of colorectal cancer after colonoscopy compared with flexible sigmoidoscopy or no lower endoscopy among older patients in the United States, 1998-2005
AU - Wang, Yize R.
AU - Cangemi, John R.
AU - Loftus, Edward V.
AU - Picco, Michael F.
N1 - Funding Information:
This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program of the National Cancer Institute, the Office of Research, Development, and Information of the Centers for Medicare & Medicaid Services, Information Management Services, Inc, and the SEER program tumor registries in the creation of the SEER-Medicare database.
PY - 2013/5
Y1 - 2013/5
N2 - Objective: To determine whether the risk of colorectal cancer (CRC) decreases after colonoscopy compared with sigmoidoscopy or no lower endoscopy. Patients and Methods: Patients 67 to 80 years old in the 5%random Medicare sample of the Surveillance, Epidemiology and End Results and Medicareelinked database were grouped into those who underwent colonoscopy or flexible sigmoidoscopy from January 1, 1998, through December 31, 2002, and those who did not undergo lower endoscopy. We excluded patients with inflammatory bowel disease, history of colon polyps, or family history of CRC. All patients were followed up until the diagnosis of CRC or carcinoma in situ, death, or December 31, 2005. The risk of CRC after colonoscopy was compared with the risk after sigmoidoscopy or no lower endoscopy. The multivariate Cox proportional hazards model was used in statistical analysis. Results: In the colonoscopy group (n=12,266), 58 CRCs (0.5%) were diagnosed during follow-up compared with 66 CRCs (1.0%) in the sigmoidoscopy group (n=6402) and 634 (1.5%) in the control group (n=41,410) (all P<.001). In the sigmoidoscopy group, 771 patients (12.0%) underwent colonoscopy within the next 12 months. In multivariate Cox regressions, colonoscopy was associated with a decreased risk of distal CRC (hazard ratio [HR], 0.266; 95%CI, 0.161-0.437) and proximal CRC (HR, 0.451; 95%CI, 0.305-0.666); sigmoidoscopy was associated with a decreased risk of distal CRC (HR, 0.409; 95%CI, 0.207-0.809) but not proximal CRC. Conclusion: Among older patients, the risk of distal CRC decreased after both colonoscopy and sigmoidoscopy; the risk of proximal CRC decreased after colonoscopy but not sigmoidoscopy.
AB - Objective: To determine whether the risk of colorectal cancer (CRC) decreases after colonoscopy compared with sigmoidoscopy or no lower endoscopy. Patients and Methods: Patients 67 to 80 years old in the 5%random Medicare sample of the Surveillance, Epidemiology and End Results and Medicareelinked database were grouped into those who underwent colonoscopy or flexible sigmoidoscopy from January 1, 1998, through December 31, 2002, and those who did not undergo lower endoscopy. We excluded patients with inflammatory bowel disease, history of colon polyps, or family history of CRC. All patients were followed up until the diagnosis of CRC or carcinoma in situ, death, or December 31, 2005. The risk of CRC after colonoscopy was compared with the risk after sigmoidoscopy or no lower endoscopy. The multivariate Cox proportional hazards model was used in statistical analysis. Results: In the colonoscopy group (n=12,266), 58 CRCs (0.5%) were diagnosed during follow-up compared with 66 CRCs (1.0%) in the sigmoidoscopy group (n=6402) and 634 (1.5%) in the control group (n=41,410) (all P<.001). In the sigmoidoscopy group, 771 patients (12.0%) underwent colonoscopy within the next 12 months. In multivariate Cox regressions, colonoscopy was associated with a decreased risk of distal CRC (hazard ratio [HR], 0.266; 95%CI, 0.161-0.437) and proximal CRC (HR, 0.451; 95%CI, 0.305-0.666); sigmoidoscopy was associated with a decreased risk of distal CRC (HR, 0.409; 95%CI, 0.207-0.809) but not proximal CRC. Conclusion: Among older patients, the risk of distal CRC decreased after both colonoscopy and sigmoidoscopy; the risk of proximal CRC decreased after colonoscopy but not sigmoidoscopy.
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U2 - 10.1016/j.mayocp.2012.12.012
DO - 10.1016/j.mayocp.2012.12.012
M3 - Article
C2 - 23522751
AN - SCOPUS:84880150064
SN - 0025-6196
VL - 88
SP - 464
EP - 470
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 5
ER -