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Protection by Endoscopy Against Death From Colorectal Cancer: A Case-Control Study Among Veterans

Protection by Endoscopy Against Death From Colorectal Cancer: A Case-Control Study Among Veterans Abstract Background: Although several clinical and epidemiologic studies suggest that timely diagnostic procedures of the large bowel may reduce mortality from colorectal cancer, the evidence for this relationship is primarily circumstantial. Methods: A case-control study was conducted among hospitalized US military veterans to investigate whether diagnostic procedures of the large bowel were performed in the period preceding the diagnosis of colorectal cancer less frequently in patients dying of colorectal cancer than in control patients. Data files of a total of 4411 veterans dying of colorectal cancer between 1988 and 1992 were extracted from the records of the US Department of Veterans Affairs, Washington, DC. Data of four living control patients and four dead control patients without colorectal cancer were matched by age, sex, and race to each case patient. The case and the two control populations were compared by conditional logistic regression, calculating odds ratios, and their 95% confidence interval. Results: Diagnostic procedures of the large bowel reduced mortality from colorectal cancer, the odds ratio being 0.41 (range, 0.33 to 0.50) for the comparison with living control patients. The protective effects of proctosigmoidoscopy, colonoscopy, and polypectomy lasted for 5 years. The procedures were protective against death from cancer of the colon, as well as cancer of the rectum. The most protective influence was associated with removal of tissue through biopsy, fulguration, and polypectomy. Similar influences were found comparing case patients with dead control patients. Conclusion: Removal of tissue represents the most effective means to reduce mortality from cancers of the large bowel. It retains its efficacy over a time period of 5 years.(Arch Intern Med. 1995;155:1741-1748) References 1. Muto T, Bussey H, Morson B. The evolution of cancer of the colon and rectum. Cancer . 1975;36:2251-2270.Crossref 2. Stryker SJ, Wolff BG, Culp CE, et al. Natural history of untreated colonic polyps. Gastroenterology . 1987;93:1009-1013. 3. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer colonoscopic polypectomy. NEngl JMed . 1993;329:1977-1981.Crossref 4. Gilbertsen VA, Nelms JM. The prevention of invasive cancer of the rectum. Cancer . 1978;41:1137-1139.Crossref 5. Selby JV, Friedman GD, Quesenberry CP, et al. A case-control study of screening sigmoidoscopy and mortality from colon cancer. N Engl J Med . 1992;326: 653-657.Crossref 6. Atkin W, Morson B, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med . 1992;326:658-662.Crossref 7. World Health Organization. The International Classification of Diseases—9th Revision: Clinical Modification . 3rd ed. Washington, DC: US Public Health Service; March 1989. Department of Public Health Services publication (PHS) 89-1260. 8. Thun MJ, Namboodiri MM, Heath CW Jr. Aspirin use and reduced risk of fatal colon cancer. N Engl J Med . 1991;325:1953-1956.Crossref 9. SAS Institute. SAS/STATSoftware: Changes and Enhancements, Release 6.07 . Cary, NC: Statistical Analysis Systems Institute Inc; 1992:435-456. 10. Buie WD, Rothenberger DA. Surveillance after curative resection of colorectal cancer. Gastrointest Endosc Clin North Am . 1993;3:691-713. 11. Cranley JP. Proper management of the patient with a malignant colorectal polyp. Gastrointest Endosc Clin North Am . 1993;3:661-671. 12. Jagelman DG. Clinical management of familial adenomatous polyposis. Cancer Surv . 1989;8:159-167. 13. Ekbom A, Helmick C, Zack M, Adami HO. Ulcerative colitis and colorectal cancer: a population-based study. N Engl J Med . 1990;323:1228-1233.Crossref 14. Ekbom A, Helmick C, Zack M, Adami H-O. Increased risk of large-bowel cancer in Crohn's disease with colonic involvement. Lancet . 1990;336:357-359.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Protection by Endoscopy Against Death From Colorectal Cancer: A Case-Control Study Among Veterans

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430160065007
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Although several clinical and epidemiologic studies suggest that timely diagnostic procedures of the large bowel may reduce mortality from colorectal cancer, the evidence for this relationship is primarily circumstantial. Methods: A case-control study was conducted among hospitalized US military veterans to investigate whether diagnostic procedures of the large bowel were performed in the period preceding the diagnosis of colorectal cancer less frequently in patients dying of colorectal cancer than in control patients. Data files of a total of 4411 veterans dying of colorectal cancer between 1988 and 1992 were extracted from the records of the US Department of Veterans Affairs, Washington, DC. Data of four living control patients and four dead control patients without colorectal cancer were matched by age, sex, and race to each case patient. The case and the two control populations were compared by conditional logistic regression, calculating odds ratios, and their 95% confidence interval. Results: Diagnostic procedures of the large bowel reduced mortality from colorectal cancer, the odds ratio being 0.41 (range, 0.33 to 0.50) for the comparison with living control patients. The protective effects of proctosigmoidoscopy, colonoscopy, and polypectomy lasted for 5 years. The procedures were protective against death from cancer of the colon, as well as cancer of the rectum. The most protective influence was associated with removal of tissue through biopsy, fulguration, and polypectomy. Similar influences were found comparing case patients with dead control patients. Conclusion: Removal of tissue represents the most effective means to reduce mortality from cancers of the large bowel. It retains its efficacy over a time period of 5 years.(Arch Intern Med. 1995;155:1741-1748) References 1. Muto T, Bussey H, Morson B. The evolution of cancer of the colon and rectum. Cancer . 1975;36:2251-2270.Crossref 2. Stryker SJ, Wolff BG, Culp CE, et al. Natural history of untreated colonic polyps. Gastroenterology . 1987;93:1009-1013. 3. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer colonoscopic polypectomy. NEngl JMed . 1993;329:1977-1981.Crossref 4. Gilbertsen VA, Nelms JM. The prevention of invasive cancer of the rectum. Cancer . 1978;41:1137-1139.Crossref 5. Selby JV, Friedman GD, Quesenberry CP, et al. A case-control study of screening sigmoidoscopy and mortality from colon cancer. N Engl J Med . 1992;326: 653-657.Crossref 6. Atkin W, Morson B, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med . 1992;326:658-662.Crossref 7. World Health Organization. The International Classification of Diseases—9th Revision: Clinical Modification . 3rd ed. Washington, DC: US Public Health Service; March 1989. Department of Public Health Services publication (PHS) 89-1260. 8. Thun MJ, Namboodiri MM, Heath CW Jr. Aspirin use and reduced risk of fatal colon cancer. N Engl J Med . 1991;325:1953-1956.Crossref 9. SAS Institute. SAS/STATSoftware: Changes and Enhancements, Release 6.07 . Cary, NC: Statistical Analysis Systems Institute Inc; 1992:435-456. 10. Buie WD, Rothenberger DA. Surveillance after curative resection of colorectal cancer. Gastrointest Endosc Clin North Am . 1993;3:691-713. 11. Cranley JP. Proper management of the patient with a malignant colorectal polyp. Gastrointest Endosc Clin North Am . 1993;3:661-671. 12. Jagelman DG. Clinical management of familial adenomatous polyposis. Cancer Surv . 1989;8:159-167. 13. Ekbom A, Helmick C, Zack M, Adami HO. Ulcerative colitis and colorectal cancer: a population-based study. N Engl J Med . 1990;323:1228-1233.Crossref 14. Ekbom A, Helmick C, Zack M, Adami H-O. Increased risk of large-bowel cancer in Crohn's disease with colonic involvement. Lancet . 1990;336:357-359.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 11, 1995

References