SAN DIEGO -- Patients who underwent screening colonoscopy in the Veterans Affairs system saw a marked reduction in colorectal cancer deaths, researchers reported here.
Any colonoscopy performed on veterans in the system was associated with a 56% reduction (OR 0.44, 95% CI 0.41-0.48) on colorectal cancer mortality when compared with controls who did did receive a colonoscopy, according to Charles Kahi, MD, of the Richard L. Roudebush VA Medical Center in Indianapolis, and colleagues.
In a model adjusted for multiple confounders, there was a 42% reduction in colorectal mortality if the cancer was located in the proximal colon (OR 0.58, 95% CI 0.51-0.66) and a 66% reduction if the cancer was found in the distal colon (OR 0.34, 95% CI 0.30-0.380, the reported at the annual Digestive Disease Week.
The results held if the patients had just undergone a screening colonoscopy, with a reduction of 58% in the odds of dying from colorectal cancer (OR 0.42, 95% CI 0.35-0.49), Kahi said at his poster presentation. He reported that screening colonoscopy was also associated with reductions in colorectal deaths regardless of anatomical location of the disease.
"In this study, colonoscopy was associated with significant reduction in colorectal cancer mortality," Kahi said. "Colonoscopy was associated with significant reductions in distal and proximal colorectal cancer mortality. If they had a colonoscopy, they were protected against colorectal cancer."
"Population-based studies have shown that receipt of colonoscopy is associated with greater protection against colorectal cancer in the distal colon then in the proximal colon," Kahi told MedPage Today. He said that until the current study there had been no assessment of the effect of colonoscopy on colorectal cancer mortality and by location in the VA system.
"The VA system doctors performed a lot of colonoscopies, but there has been no real assessment of outcomes," he said. "This study fills a gap specifically for the VA, but also for the U.S."
The authors performed a case-control study by combing the linked Veterans Affairs-Center for Medicare and Medicaid Services (VA-CMS) data. They included veterans at least 52-years-old who were diagnosed with colorectal cancer from January 2002 to the end of December 2008, and who had died by the end of 2010.
Controls were veterans with a minimum age of 50, but without colorectal cancer or death from colorectal cancer through the end of 2010. Each case was matched for age, sex, and VA facility and was matched with four controls. Patients with a previous diagnosis of colorectal cancer, colon surgery, inflammatory bowel disease, or polyposis were excluded.
They identified 7,363 cases and 29,452 controls. Of the cases, 881 individuals had received a colonoscopy compared with 6,535 controls. The mean age of the patients included in the study was 73. Because the study was conducted at VA facilities, 98.8% of the patients in the study were men.
V. Paul Doria-Rose, PhD, of the National Cancer Institute in Bethesda, Md., told MedPage Today that "these results are what I would expect to see. The relative impact in reducing colorectal cancer mortality is what is seen in other groups." Doria-Rose was not involved in the study.
Kahi said the take-home message from the findings was "have the colonoscopy. Get it done."
Kahi disclosed no relevant relationships with industry.
Doria-Rose disclosed no relevant relationships with industry.
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