Xabier García-Albéniz1, John Hsu1, Michael Bretthauer1, Miguel A Hernán1. 1. From Harvard T.H. Chan School of Public Health, Massachusetts General Hospital, Harvard Medical School, and Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts; and University of Oslo and Oslo University Hospital, Oslo, Norway.
Abstract
BACKGROUND: No randomized, controlled trials of screening colonoscopy have been completed, and ongoing trials exclude persons aged 75 years or older. The Medicare program, however, reimburses screening colonoscopy without an upper age limit. OBJECTIVE: To evaluate the effectiveness and safety of screening colonoscopy to prevent colorectal cancer (CRC) in persons aged 70 to 74 and those aged 75 to 79 years. DESIGN: Large-scale, population-based, prospective study. The observational data were used to emulate a target trial with 2 groups: colonoscopy screening and no screening. SETTING: United States. PARTICIPANTS: 1 355 692 Medicare beneficiaries (2004 to 2012) aged 70 to 79 years at average risk for CRC who used Medicare preventive services and had no previous diagnostic or surveillance colonoscopies in the past 5 years. MEASUREMENTS: 8-year risk for CRC and 30-day risk for adverse events. RESULTS: In beneficiaries aged 70 to 74 years, the 8-year risk for CRC was 2.19% (95% CI, 2.00% to 2.37%) in the screening colonoscopy group and 2.62% (CI, 2.56% to 2.67%) in the no-screening group (absolute risk difference, -0.42% [CI, -0.24% to -0.63%]). Among those aged 75 to 79 years, the 8-year risk for CRC was 2.84% (CI, 2.54% to 3.13%) in the screening colonoscopy group and 2.97% (CI, 2.92% to 3.03%) in the no-screening group (risk difference, -0.14% [CI, -0.41 to 0.16]). The excess 30-day risk for any adverse event in the colonoscopy group was 5.6 events per 1000 individuals (CI, 4.4 to 6.8) in the 70- to 74-year age group and 10.3 per 1000 (CI, 8.6 to 11.1) in the 75- to 79-year age group. LIMITATION: CRC-specific mortality was not available, but CRC incidence and stage were studied at diagnosis. CONCLUSION: Screening colonoscopy may have had a modest benefit in preventing CRC in beneficiaries aged 70 to 74 years and a smaller benefit in older beneficiaries. The risk for adverse events was low but greater among older persons. PRIMARY FUNDING SOURCE: National Institutes of Health.
BACKGROUND: No randomized, controlled trials of screening colonoscopy have been completed, and ongoing trials exclude persons aged 75 years or older. The Medicare program, however, reimburses screening colonoscopy without an upper age limit. OBJECTIVE: To evaluate the effectiveness and safety of screening colonoscopy to prevent colorectal cancer (CRC) in persons aged 70 to 74 and those aged 75 to 79 years. DESIGN: Large-scale, population-based, prospective study. The observational data were used to emulate a target trial with 2 groups: colonoscopy screening and no screening. SETTING: United States. PARTICIPANTS: 1 355 692 Medicare beneficiaries (2004 to 2012) aged 70 to 79 years at average risk for CRC who used Medicare preventive services and had no previous diagnostic or surveillance colonoscopies in the past 5 years. MEASUREMENTS: 8-year risk for CRC and 30-day risk for adverse events. RESULTS: In beneficiaries aged 70 to 74 years, the 8-year risk for CRC was 2.19% (95% CI, 2.00% to 2.37%) in the screening colonoscopy group and 2.62% (CI, 2.56% to 2.67%) in the no-screening group (absolute risk difference, -0.42% [CI, -0.24% to -0.63%]). Among those aged 75 to 79 years, the 8-year risk for CRC was 2.84% (CI, 2.54% to 3.13%) in the screening colonoscopy group and 2.97% (CI, 2.92% to 3.03%) in the no-screening group (risk difference, -0.14% [CI, -0.41 to 0.16]). The excess 30-day risk for any adverse event in the colonoscopy group was 5.6 events per 1000 individuals (CI, 4.4 to 6.8) in the 70- to 74-year age group and 10.3 per 1000 (CI, 8.6 to 11.1) in the 75- to 79-year age group. LIMITATION: CRC-specific mortality was not available, but CRC incidence and stage were studied at diagnosis. CONCLUSION: Screening colonoscopy may have had a modest benefit in preventing CRC in beneficiaries aged 70 to 74 years and a smaller benefit in older beneficiaries. The risk for adverse events was low but greater among older persons. PRIMARY FUNDING SOURCE: National Institutes of Health.
Authors: David A Lieberman; Douglas K Rex; Sidney J Winawer; Francis M Giardiello; David A Johnson; Theodore R Levin Journal: Gastroenterology Date: 2012-07-03 Impact factor: 22.682
Authors: Enrique Quintero; Antoni Castells; Luis Bujanda; Joaquín Cubiella; Dolores Salas; Ángel Lanas; Montserrat Andreu; Fernando Carballo; Juan Diego Morillas; Cristina Hernández; Rodrigo Jover; Isabel Montalvo; Juan Arenas; Eva Laredo; Vicent Hernández; Felipe Iglesias; Estela Cid; Raquel Zubizarreta; Teresa Sala; Marta Ponce; Mercedes Andrés; Gloria Teruel; Antonio Peris; María-Pilar Roncales; Mónica Polo-Tomás; Xavier Bessa; Olga Ferrer-Armengou; Jaume Grau; Anna Serradesanferm; Akiko Ono; José Cruzado; Francisco Pérez-Riquelme; Inmaculada Alonso-Abreu; Mariola de la Vega-Prieto; Juana Maria Reyes-Melian; Guillermo Cacho; José Díaz-Tasende; Alberto Herreros-de-Tejada; Carmen Poves; Cecilio Santander; Andrés González-Navarro Journal: N Engl J Med Date: 2012-02-23 Impact factor: 91.245
Authors: Aasma Shaukat; Steven J Mongin; Mindy S Geisser; Frank A Lederle; John H Bond; Jack S Mandel; Timothy R Church Journal: N Engl J Med Date: 2013-09-19 Impact factor: 91.245
Authors: Michael Bretthauer; Michal F Kaminski; Magnus Løberg; Ann G Zauber; Jaroslaw Regula; Ernst J Kuipers; Miguel A Hernán; Eleanor McFadden; Annike Sunde; Mette Kalager; Evelien Dekker; Iris Lansdorp-Vogelaar; Kjetil Garborg; Maciej Rupinski; Manon C W Spaander; Marek Bugajski; Ole Høie; Tryggvi Stefansson; Geir Hoff; Hans-Olov Adami Journal: JAMA Intern Med Date: 2016-07-01 Impact factor: 21.873
Authors: Amir Qaseem; Carolyn J Crandall; Reem A Mustafa; Lauri A Hicks; Timothy J Wilt; Mary Ann Forciea; Nick Fitterman; Carrie A Horwitch; Devan Kansagara; Michael Maroto; Robert M McLean; Jairo Roa; Janice Tufte Journal: Ann Intern Med Date: 2019-11-05 Impact factor: 25.391
Authors: Audrey H Calderwood; Tor D Tosteson; Louise C Walter; Peiying Hua; Tracy Onega Journal: J Am Geriatr Soc Date: 2021-12-03 Impact factor: 5.562
Authors: Matthew D Rutter; James East; Colin J Rees; Neil Cripps; James Docherty; Sunil Dolwani; Philip V Kaye; Kevin J Monahan; Marco R Novelli; Andrew Plumb; Brian P Saunders; Siwan Thomas-Gibson; Damian J M Tolan; Sophie Whyte; Stewart Bonnington; Alison Scope; Ruth Wong; Barbara Hibbert; John Marsh; Billie Moores; Amanda Cross; Linda Sharp Journal: Gut Date: 2019-11-27 Impact factor: 31.793
Authors: Yu-Han Chiu; Jorge E Chavarro; Barbra A Dickerman; JoAnn E Manson; Kenneth J Mukamal; Kathryn M Rexrode; Eric B Rimm; Miguel A Hernán Journal: Am J Clin Nutr Date: 2021-08-02 Impact factor: 8.472