Colonoscopy by gastroenterologist reduced risk of colorectal death

Issue: July 25, 2012

Patients who had undergone a colonoscopy were found to have a reduced risk for death due to colorectal disease, according to results of a US cohort study.

The study included all patients in SEER identified as having had colorectal cancer between age 70 and 89 years from January 1998 to December 2002 who died as a result of their disease.

Each of these patients was matched with three controls who had no history of cancer. All patients had to have undergone colonoscopy from January 2001 to 6 months prior to their diagnosis.

SEER included data on 9,458 colorectal cancer cases, Of them, 41.9% of cases were proximal and 49.5% were distal. These patients were matched with 27,641 controls. The median age of patients at colorectal cancer diagnosis was 80 years. Colonoscopy within 6 months of diagnosis occurred in 11.3% of patients.

Those identified as having colorectal cancer were 60% less likely than control patients to have undergone colonoscopy (95% CI, 0.37-0.43; P<.001). As researchers hypothesized, this association was stronger for distal cancers (OR=0.24; 95% CI, 0.21-0.27) than it was for proximal cancers (OR=0.58; 95% CI, 0.53-0.64).

In addition, the researchers wrote that their study “provides evidence to support a relationship between quality of colonoscopy and effectiveness.”

Indeed, they found that the association of colonoscopy with colorectal cancer varied according to the specialty of the colonoscopist.

Specifically, those who had colonoscopy performed by a gastroenterologist had the greatest reduction in risk for colorectal death (OR=0.35; 95% CI, 0.32-0.39) compared with either a surgeon (OR=0.55; 95% CI, 0.47-0.64) or a primary care provider (OR=0.43; 95% CI, 0.33-0.55).

“Given the expense and risks associated with screening colonoscopy, ensuring quality through training, credentialing and direct measurement should be an essential component of any colorectal screening program,” the researchers concluded.

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Sources/Disclosures

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Source:

Baxter NN. J Clin Oncol. 2012;doi:10.1200/JCO.2011.40.4772.