Hermann Brenner, MD, MPH; Jenny Chang-Claude, PhD; Christoph M. Seiler, MD, MSc; Alexander Rickert, MD; Michael Hoffmeister, PhD
Acknowledgment: The authors thank Ute Handte-Daub for her excellent technical assistance. They are grateful to the study participants and the interviewers who collected the data. The authors also thank the following hospitals and cooperating institutions that recruited patients for this study: Chirurgische Universitätsklinik Heidelberg, Klinik am Gesundbrunnen Heilbronn, Sankt Vincentiuskrankenhaus Speyer, Sankt Josefskrankenhaus Heidelberg, Chirurgische Universitätsklinik Mannheim, Diakonissenkrankenhaus Speyer, Krankenhaus Salem Heidelberg, Kreiskrankenhaus Schwetzingen, Sankt Marien- und Sankt Annastiftkrankenhaus Ludwigshafen, Klinikum Ludwigshafen, Stadtklinik Frankenthal, Diakoniekrankenhaus Mannheim, Kreiskrankenhaus Sinsheim, Klinikum am Plattenwald Bad Friedrichshall, Kreiskrankenhaus Weinheim, Kreiskrankenhaus Eberbach, Kreiskrankenhaus Buchen, Kreiskrankenhaus Mosbach, Enddarmzentrum Mannheim, Kreiskrankenhaus Brackenheim, and Cancer Registry of Rhineland-Palatinate in Mainz.
Grant Support: By the German Research Council (BR 1704/6-1, BR 1704/6-3, BR 1704/6-4, and CH 117/1-1) and the German Federal Ministry of Education and Research (01KH0404 and 01ER0814).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1362.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available by request from and written agreement with Dr. Brenner (e-mail, h.brenner@Dkfz-Heidelberg.de).
Requests for Single Reprints: Hermann Brenner, MD, MPH, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany; e-mail, h.brenner@Dkfz-Heidelberg.de.
Current Author Addresses: Drs. Brenner and Hoffmeister: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany.
Dr. Chang-Claude: Division of Cancer Epidemiology, Unit of Genetic Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany.
Dr. Seiler: Department of General, Visceral, and Trauma Surgery, University Clinic Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
Dr. Rickert: Department of Surgery, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
Author Contributions: Conception and design: H. Brenner, J. Chang-Claude, C.M. Seiler, M. Hoffmeister.
Analysis and interpretation of the data: H. Brenner, C.M. Seiler, M. Hoffmeister.
Drafting of the article: H. Brenner.
Critical revision of the article for important intellectual content: H. Brenner, J. Chang-Claude, C.M. Seiler, M. Hoffmeister.
Final approval of the article: H. Brenner, J. Chang-Claude, C.M. Seiler, M. Hoffmeister.
Provision of study materials or patients: A. Rickert.
Statistical expertise: H. Brenner.
Obtaining of funding: H. Brenner, J. Chang-Claude.
Administrative, technical, or logistic support: C.M. Seiler, M. Hoffmeister.
Collection and assembly of data: H. Brenner, C.M. Seiler, M. Hoffmeister.
Brenner H, Chang-Claude J, Seiler CM, Rickert A, Hoffmeister M. Protection From Colorectal Cancer After Colonoscopy: A Population-Based, Case–Control Study. Ann Intern Med. 2011;154:22-30. doi: 10.7326/0003-4819-154-1-201101040-00004
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Published: Ann Intern Med. 2011;154(1):22-30.
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.
To assess the association between previous colonoscopy and risk for CRC.
Population-based case–control study.
Rhine-Neckar region of Germany.
A total of 1688 case patients with colorectal cancer and 1932 control participants aged 50 years or older.
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.
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.
The study was observational, with potential for residual confounding and selection bias.
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.
German Research Council and German Federal Ministry of Education and Research.
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Gastroenterology/Hepatology, Hematology/Oncology, Colonoscopy/Sigmoidoscopy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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