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Ann Intern Med. 2011 Jan 4;154(1):22-30. doi: 10.7326/0003-4819-154-1-201101040-00004.

Protection from colorectal cancer after colonoscopy: a population-based, case-control study.

Author information

  • 1German Cancer Research Center, University Clinic Heidelberg, University of Heidelberg, Germany. h.brenner@Dkfz-Heidelberg.de

Abstract

BACKGROUND:

Colonoscopy with detection and removal of adenomas is considered a powerful tool to reduce colorectal cancer (CRC) incidence. However, the degree of protection achievable in a population setting with high-quality colonoscopy resources remains to be quantified.

OBJECTIVE:

To assess the association between previous colonoscopy and risk for CRC.

DESIGN:

Population-based case-control study.

SETTING:

Rhine-Neckar region of Germany.

PATIENTS:

A total of 1688 case patients with colorectal cancer and 1932 control participants aged 50 years or older.

MEASUREMENTS:

A detailed lifetime history of CRC risk factors and preventive factors, including history and results of previous colonoscopies, and of medical data obtained by self-reports and medical records. Odds ratios of CRC associated with colonoscopy in the preceding 10 years were estimated, after adjustment for sex, age, education level, participation in a general health screening examination, family history of CRC, smoking status, body mass index, and use of nonsteroidal anti-inflammatory drugs or hormone replacement therapy.

RESULTS:

Overall, colonoscopy in the preceding 10 years was associated with 77% lower risk for CRC. Adjusted odds ratios for any CRC, right-sided CRC, and left-sided CRC were 0.23 (95% CI, 0.19 to 0.27), 0.44 (CI, 0.35 to 0.55), and 0.16 (CI, 0.12 to 0.20), respectively. Strong risk reduction was observed for all cancer stages and all ages, except for right-sided cancer in persons aged 50 to 59 years. Risk reduction increased over the years in both the right and the left colon.

LIMITATION:

The study was observational, with potential for residual confounding and selection bias.

CONCLUSION:

Colonoscopy with polypectomy can be associated with strongly reduced risk for CRC in the population setting. Aside from strong risk reduction with respect to left-sided CRC, risk reduction of more than 50% was also seen for right-sided colon cancer.

PRIMARY FUNDING SOURCE:

German Research Council and German Federal Ministry of Education and Research.

Comment in

PMID:
21200035
[PubMed - indexed for MEDLINE]
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