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The Impact of Screening on Colorectal Cancer Mortality and Incidence: Has It Really Made a Difference?

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Abstract

About sixty percent of the US population of those age fifty and older are currently up to date with colorectal cancer screening recommendations. Has this level of screening made a difference for reducing colorectal cancer (CRC) incidence and/or mortality? Randomized controlled trials of guaiac-based fecal occult blood tests, which have relatively low sensitivity but high specificity for CRC, have shown a modest effect but with a long-term reduction in CRC mortality. Newer fecal immunochemical tests are expected to have a greater effect. Randomized controlled trials of flexible sigmoidoscopy have also demonstrated a reduction in CRC mortality. Observational studies of screening colonoscopy suggest an effect of greater than fifty percent reduction in CRC mortality. We have assessed past trends of colorectal cancer screening in the US population which suggest that more than fifty percent of the decline in colorectal cancer mortality can be attributed to the increased acceptance and uptake in colorectal cancer screening. Current and future levels of increased screening could provide for even larger reductions for the USA. Colorectal cancer screening has and will continue to make a significant impact on reducing colorectal cancer mortality.

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References

  1. Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2011, National Cancer Institute, Bethesda, MD. http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER website, April 2014.

  2. Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–1477.

    Article  CAS  PubMed  Google Scholar 

  3. Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–1471.

    Article  CAS  PubMed  Google Scholar 

  4. Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328:1365–1371.

    Article  CAS  PubMed  Google Scholar 

  5. Mandel JS, Church TR, Bond JH, et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med. 2000;343:1603–1607.

    Article  CAS  PubMed  Google Scholar 

  6. Shaukat A, Mongin SJ, Geisser MS, et al. Long-term mortality after screening for colorectal cancer. N Engl J Med. 2013;369:1106–1114.

    Article  CAS  PubMed  Google Scholar 

  7. Hewitson P, Glasziou P, Watson E, Towler B, Irwig L. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol. 2008;103:1541–1549.

    Article  PubMed  Google Scholar 

  8. Atkin WS. Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial. Lancet. 2002;359:1291–1300.

    Article  CAS  PubMed  Google Scholar 

  9. Segnan N, Armaroli P, Bonelli L, et al. Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian Randomized Controlled Trial–SCORE. J Natl Cancer Inst. 2011;103:1310–1322.

    Article  PubMed  Google Scholar 

  10. Schoen RE, Pinsky PF, Weissfeld JL, et al. Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med. 2012;366:2345–2357.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Holme O, Loberg M, Kalager M, et al. Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: a randomized clinical trial. JAMA. 2014;312:606–615.

    Article  CAS  PubMed  Google Scholar 

  12. Klabunde CN, Cronin KA, Breen N, Waldron WR, Ambs AH, Nadel MR. Trends in colorectal cancer test use among vulnerable populations in the United States. Cancer Epidemiol Biomark Prev. 2011;20:1611–1621.

    Article  Google Scholar 

  13. Podolsky DK. Going the distance—the case for true colorectal-cancer screening. N Engl J Med. 2000;343:207–208.

    Article  CAS  PubMed  Google Scholar 

  14. Quintero E, Castells A, Bujanda L, et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med. 2012;366:697–706.

    Article  CAS  PubMed  Google Scholar 

  15. Kaminski MF, Bretthauer M, Zauber AG, et al. The NordICC Study: Rationale and design of a randomized trial on colonoscopy screening for colorectal cancer. Endoscopy. 2012;44:695–702.

    Article  CAS  PubMed  Google Scholar 

  16. Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology. 1997;112:594–642.

    Article  CAS  PubMed  Google Scholar 

  17. Levin B, Brooks D, Smith RA, Stone A. Emerging technologies in screening for colorectal cancer: CT colonography, immunochemical fecal occult blood tests, and stool screening using molecular markers. CA Cancer J Clin. 2003;53:44–55.

    Article  PubMed  Google Scholar 

  18. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–1595.

    Article  CAS  PubMed  Google Scholar 

  19. Lee JK, Liles EG, Bent S, Levin TR, Corley DA. Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. Ann Intern Med. 2014;160:171.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Allison JE, Fraser CG, Halloran SP, Young GP. Population screening for colorectal cancer means getting FIT: the past, present, and future of colorectal cancer screening using the fecal immunochemical test for hemoglobin (FIT). Gut Liver. 2014;8:117–130.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Allison JE, Lawson M. Screening tests for colorectal cancer: a menu of options remains relevant. Curr Oncol Rep. 2006;8:492–498.

    Article  CAS  PubMed  Google Scholar 

  22. Allison JE, Sakoda LC, Levin TR, et al. Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics. J Natl Cancer Inst. 2007;99:1462–1470.

    Article  PubMed  Google Scholar 

  23. Allison JE, Tekawa IS, Ransom LJ, Adrain AL. A comparison of fecal occult-blood tests for colorectal-cancer screening. N Engl J Med. 1996;334:155–159.

    Article  CAS  PubMed  Google Scholar 

  24. Brenner H, Tao S. Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy. Eur J Cancer (Oxford, England). 1990;2013:3049–3054.

    Google Scholar 

  25. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370:1287–1297.

    Article  CAS  PubMed  Google Scholar 

  26. Winawer SJ, Flehinger BJ, Schottenfeld D, Miller DG. Screening for colorectal cancer with fecal occult blood testing and sigmoidoscopy. J Natl Cancer Inst. 1993;85:1311–1318.

    Article  CAS  PubMed  Google Scholar 

  27. Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008;359:1207–1217.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Pickhardt PJ, Choi JR, Hwang I, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003;349:2191–2200. doi:10.1007/s1620-014-3454-2.

    Article  CAS  PubMed  Google Scholar 

  29. Bertario L, Russo A, Crosignani P, et al. Reducing colorectal cancer mortality by repeated faecal occult blood test: a nested case-control study. Eur J Cancer (Oxford, England). 1990;1999:973–977.

    Google Scholar 

  30. Faivre J, Tazi MA, El Mrini T, Lejeune C, Benhamiche AM, Dassonville F. Faecal occult blood screening and reduction of colorectal cancer mortality: a case-control study. Br J Cancer. 1999;79:680–683.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Lazovich D, Weiss NS, Stevens NG, White E, McKnight B, Wagner EH. A case-control study to evaluate efficacy of screening for faecal occult blood. J Med Screen. 1995;2:84–89.

    CAS  PubMed  Google Scholar 

  32. Nakama H. A study on the efficacy of a screening program for colorectal cancer in a small Japanese village. Clin Invest. 1994;72:117–121.

    CAS  Google Scholar 

  33. Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS. Effect of fecal occult blood testing on mortality from colorectal cancer. A case–control study. Ann Int Med. 1993;118:1–6.

    Article  CAS  PubMed  Google Scholar 

  34. Wahrendorf J, Robra BP, Wiebelt H, Oberhausen R, Weiland M, Dhom G. Effectiveness of colorectal cancer screening: results from a population-based case-control evaluation in Saarland. Germany Eur J Cancer Prev. 1993;2:221–227.

    Article  CAS  Google Scholar 

  35. Zappa M, Castiglione G, Grazzini G, et al. Effect of faecal occult blood testing on colorectal mortality: results of a population-based case-control study in the district of Florence, Italy. Int J Cancer. 1997;73:208–210.

    Article  CAS  PubMed  Google Scholar 

  36. Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653–657.

    Article  CAS  PubMed  Google Scholar 

  37. Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst. 1992;84:1572–1575.

    Article  CAS  PubMed  Google Scholar 

  38. Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Int Med. 2009;150:1–8.

    Article  PubMed  Google Scholar 

  39. Baxter NN, Warren JL, Barrett MJ, Stukel TA, Doria-Rose VP. Association between colonoscopy and colorectal cancer mortality in a US cohort according to site of cancer and colonoscopist specialty. J Clin Oncol. 2012;30:2664–2669.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Doubeni CA, Weinmann S, Adams K, et al. Screening colonoscopy and risk for incident late-stage colorectal cancer diagnosis in average-risk adults: a nested case-control study. Ann Int Med. 2013;158:312–320.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Kahi CJ, Imperiale TF, Juliar BE, Rex DK. Effect of screening colonoscopy on colorectal cancer incidence and mortality. Clin Gastroenterol Hepatol. 2009;7:770–775; quiz 711.

  42. Nishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013;369:1095–1105.

    Article  CAS  PubMed  Google Scholar 

  43. Hixson LJ, Fennerty MB, Sampliner RE, Garewal HS. Prospective blinded trial of the colonoscopic miss-rate of large colorectal polyps. Gastrointest Endosc. 1991;37:125–127.

    Article  CAS  PubMed  Google Scholar 

  44. Hixson LJ, Fennerty MB, Sampliner RE, McGee D, Garewal H. Prospective study of the frequency and size distribution of polyps missed by colonoscopy. J Natl Cancer Inst. 1990;82:1769–1772.

    Article  CAS  PubMed  Google Scholar 

  45. Rex DK, Cutler CS, Lemmel GT, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112:24–28.

    Article  CAS  PubMed  Google Scholar 

  46. Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–696.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  47. Loberg M, Kalager M, Holme O, Hoff G, Adami HO, Bretthauer M. Long-term colorectal-cancer mortality after adenoma removal. N Engl J Med. 2014;371:799–807.

    Article  PubMed  Google Scholar 

  48. Loeve F, van Ballegooijen M, Boer R, Kuipers EJ, Habbema JD. Colorectal cancer risk in adenoma patients: a nation-wide study. Int J Cancer. 2004;111:147–151.

    Article  CAS  PubMed  Google Scholar 

  49. Robertson DJ, Greenberg E, Beach M, et al. Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterol. 2005;129:34–41.

    Article  Google Scholar 

  50. Zauber AG, Winawer SJ. High-quality colonoscopies must be an integral part of screening and surveillance programs. Gastroenterology. 2006;130:620–621; author reply 621–622.

  51. Lieberman DA, Weiss DG, Harford WV, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007;133:1077–1085.

    Article  PubMed  Google Scholar 

  52. Brenner H, Haug U, Arndt V, Stegmaier C, Altenhofen L, Hoffmeister M. Low risk of colorectal cancer and advanced adenomas more than 10 years after negative colonoscopy. Gastroenterology. 2010;138:870–876.

    Article  PubMed  Google Scholar 

  53. Singh H, Nugent Z, Mahmud SM, Demers AA, Bernstein CN. Predictors of colorectal cancer after negative colonoscopy: a population-based study. Am J Gastroenterol. 2010;105:663–673; quiz 674.

  54. Singh H, Turner D, Xue L, Targownik LE, Bernstein CN. Risk of developing colorectal cancer following a negative colonoscopy examination: evidence for a 10-year interval between colonoscopies. JAMA. 2006;295:2366–2373.

    Article  CAS  PubMed  Google Scholar 

  55. Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370:1298–1306.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  56. Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–1803.

    Article  CAS  PubMed  Google Scholar 

  57. Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, van Ballegooijen M, Kuntz KM. Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:659–669.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Vogelaar I, van Ballegooijen M, Schrag D, et al. How much can current interventions reduce colorectal cancer mortality in the U.S.? Mortality projections for scenarios of risk-factor modification, screening, and treatment. Cancer. 2006;107:1624–1633.

    Article  PubMed  Google Scholar 

  59. Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–573.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Meester RG, Doubeni C, Lansdorp-Vogelaar I, et al. Colorectal deaths attributable to non-use of screening in the United States. Ann Epidemiol. 2015;25:208–213.

    Article  PubMed  Google Scholar 

  61. Lee JK, Levin TR, Corley DA. The road ahead: what if gastroenterologists were accountable for preventing colorectal cancer? Clin Gastroenterol Hepatol. 2013;11:204–207.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Lansdorp-Vogelaar I, Kuntz KM, Knudsen AB, van Ballegooijen M, Zauber AG, Jemal A. Contribution of screening and survival differences to racial disparities in colorectal cancer rates. Cancer Epidemiol Biomark Prev. 2012;21:728–736.

    Article  Google Scholar 

  63. Jemal A, Siegel RL, Ma J, et al. Inequalities in premature death from colorectal cancer by state. J Clin Oncol. 2014. doi:10.1200/JCO.2014.58.7519.

    Google Scholar 

  64. Mandel JS, Church TR, Ederer F, Bond JH. Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood. J Natl Cancer Inst. 1999;91:434–437.

    Article  CAS  PubMed  Google Scholar 

  65. Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet. 2010;375:1624–1633.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work is supported in part from the following grants: U01 CA-152959, U01 CA-151736, U54 CA-163262, R01 CA-079572, and P30 CA008748.

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Correspondence to Ann G. Zauber.

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Zauber, A.G. The Impact of Screening on Colorectal Cancer Mortality and Incidence: Has It Really Made a Difference?. Dig Dis Sci 60, 681–691 (2015). https://doi.org/10.1007/s10620-015-3600-5

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