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Colonoscopy associated with fewer deaths from left-sided colorectal cancers

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Researchers in Ontario used data from a case-control study to determine that colonoscopy was associated with a decreased risk for disease-specific mortality in patients with colorectal cancer.

The researchers evaluated 10,292 case patients and 51,460 matched controls. Patients were selected using administrative data claims from the Ontario Health Insurance plan between January 1992 and December 2003. Each patient had five controls matched for sex, income quintile, location by health care region and birth year. Participants were aged 52 to 90 years.

Results indicate that case patients were less likely to have undergone both complete colonoscopy (OR=0.63; 95% CI, 0.57-0.69) or attempted colonoscopy (OR=0.69; 95% CI, 0.63-0.74).

The researchers found that colonoscopy was associated with a lower mortality rate for patients with left-sided disease whether they had attempted colonoscopy (OR=0.39; 95% CI, 0.34-0.45) or complete colonoscopy (OR=0.33; 95% CI, 0.28-0.39). The same was not true for patients with right-sided disease for either attempted colonoscopy (OR=1.07; 95% CI, 0.94=1.21) or complete colonoscopy (OR=0.99; 95% CI, 0.86-1.14).

In an accompanying editorial, David F. Ransohoff, MD, a professor at the Lineberger Comprehensive Cancer Center, Chapel Hill, N.C., noted that fast-growing tumors are more likely to be fatal and that there is some evidence that right-sided neoplasms are more likely to be fast-growing.

More frequent colonoscopies could reduce that risk for death, but the procedure has risks of its own, he wrote.

“Colonoscopy is an effective intervention, but, as Baxter and colleagues suggest, we must realize that current evidence is indirect and does not support a claim of 90% effectiveness,” Ransohoff wrote. “Until we have better data, we can be grateful and optimistic to have a useful intervention to offer our patients, but we should be realistic and cautious when talking with them about the magnitude of both benefits and risks.”

Ann Intern Med. 2009;150:1-8.