Xabier García-Albéniz, MD, PhD; John Hsu, MD, MBA, MSCE; Michael Bretthauer, MD, PhD; Miguel A. Hernán, MD, DrPH
Grant Support: By National Institutes of Health (NIH) grants P01-AG032952, P01-CA134294, R01-CA164023, and R01-HS023128.
Disclosures: Dr. Hsu reports grants from the NIH and Agency for Healthcare Research and Quality during the conduct of the study. Dr. Hernán reports grants from the NIH/National Cancer Institute during the conduct of the study. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0758.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: See the Appendix. Statistical code: Available from Dr. García-Albéniz (e-mail, firstname.lastname@example.org). Data set: Available from the Centers for Medicare & Medicaid Services (www.cms.gov).
Requests for Single Reprints: Xabier García-Albéniz, MD, PhD, Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115; e-mail, email@example.com.
Current Author Addresses: Drs. García-Albéniz and Hernán: Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115.
Dr. Hsu: Mongan Institute, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.
Dr. Bretthauer: Institute of Health and Society, University of Oslo, PO Box 1089, Blindern 0318, Oslo, Norway.
Author Contributions: Conception and design: X. García-Albéniz, J. Hsu, M. Bretthauer, M.A. Hernán.
Analysis and interpretation of the data: X. García-Albéniz, J. Hsu, M. Bretthauer, M.A. Hernán.
Drafting of the article: X. García-Albéniz, M.A. Hernán.
Critical revision for important intellectual content: X. García-Albéniz, J. Hsu, M. Bretthauer, M.A. Hernán.
Final approval of the article: X. García-Albéniz, J. Hsu, M. Bretthauer, M.A. Hernán.
Provision of study materials or patients: J. Hsu.
Statistical expertise: X. García-Albéniz, M.A. Hernán.
Obtaining of funding: J. Hsu, M.A. Hernán.
Administrative, technical, or logistic support: M.A. Hernán.
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.
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.
Large-scale, population-based, prospective study. The observational data were used to emulate a target trial with 2 groups: colonoscopy screening and no screening.
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.
8-year risk for CRC and 30-day risk for adverse events.
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.
CRC-specific mortality was not available, but CRC incidence and stage were studied at diagnosis.
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.
National Institutes of Health.
García-Albéniz X, Hsu J, Bretthauer M, Hernán MA. Effectiveness of Screening Colonoscopy to Prevent Colorectal Cancer Among Medicare Beneficiaries Aged 70 to 79 Years: A Prospective Observational Study. Ann Intern Med. ;166:18–26. doi: 10.7326/M16-0758
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Published: Ann Intern Med. 2017;166(1):18-26.
Published at www.annals.org on 27 September 2016
Colonoscopy/Sigmoidoscopy, Colorectal Cancer, Gastroenterology/Hepatology, Gastrointestinal Cancer, Healthcare Delivery and Policy.
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