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Letters |18 September 2018

Colonoscopy and Colorectal Cancer Mortality

Charles J. Kahi, MD, MSc; Heiko Pohl, MD; Laura J. Myers, PhD; Douglas J. Robertson, MD; Thomas F. Imperiale, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • Richard L. Roudebush VA Medical Center and Indiana University School of Medicine, Indianapolis, Indiana (C.J.K., L.J.M.)
    VA White River Junction, White River Junction, Vermont (H.P.)
    VA Medical Center, White River Junction, Vermont (D.J.R.)
    Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (T.F.I.)

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0723.

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IN RESPONSE:
Drs. Xirasagar and de Groen state that our results may overestimate mortality reduction after exposure to colonoscopy in the Veterans Affairs health system. Although most of the issues they raised were addressed in our article, we will clarify further.
Drs. Xirasagar and de Groen contend that colonoscopy status was unreliable because the algorithm used was only 70% sensitive; however, this validated algorithm is used to ascertain colonoscopy indication, not exposure to colonoscopy. The 70% sensitivity could have contributed to misclassification based on indication; thus, the secondary analysis focused on screening colonoscopy but is not relevant to the primary analysis for which colonoscopy exposure ascertainment was complete.
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Kahi CJ, Pohl H, Myers LJ, Robertson DJ, Imperiale TF. Colonoscopy and Colorectal Cancer Mortality. Ann Intern Med. ;169:424–425. doi: 10.7326/L18-0297

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Published: Ann Intern Med. 2018;169(6):424-425.

DOI: 10.7326/L18-0297

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