Researchers estimate that undergoing colonoscopy within the previous 10 years prevented death from colorectal cancer in about 50,400 Americans and about 25,600 Germans aged 55 to 79 years between 2008 and 2011.
They also concluded that if 100% of eligible adults had undergone colonoscopy screening in the previous 10 years, about 36% of the 109,479 deaths from colorectal cancer in the U.S. and about 37% of the 57,591 deaths from colorectal cancer in Germany would have been prevented during the same period.
“Colonoscopy use within 10 years prevented a considerable fraction of CRC mortality in Germany and the United States during 2008 to 2011, and there is a large potential for further reducing the mortality by increasing colonoscopy utilization, either as primary screening examination or to follow-up positive results of promising noninvasive screening tests, such as FITs, in the target population,” researchers from the German Cancer Research Center in Heidelberg, Germany, wrote.
To assess the public health impact of recent colonoscopy use in the U.S. and Germany, the researchers conducted a population-based analysis using data from nationally representative surveys, medical literature and CRC death registries. They combined these data to calculate impact numbers and the epidemiological metrics of attributable fraction and prevented fraction.
Attributable fraction was defined as the percentage of CRC deaths likely to be attributed to not having a colonoscopy within 10 years, and also the maximum reduction in the percentage of CRC deaths if the colonoscopy screening rate were 100%. Prevented fraction was defined as the percentage of hypothetical CRC deaths prevented by recent colonoscopy.
The investigators found that 55.8% of Americans aged 55 to 79 years had a colorectal endoscopy within the past 10 years in 2008, compared with 60.4% in 2010. In Germany, 54.8% of adults in the eligible age range had a colonoscopy within the past 10 years between 2008 and 2011.
The investigators attributed nonuse of colonoscopy to 38.2% (95% CI, 28.6-47.1) of U.S. deaths from CRC from 2008 to 2009, and 33.6% (95% CI, 24.8-42.2) of U.S. deaths from CRC from 2010 to 2011. In Germany, they attributed 36.6% (95% CI, 27.3-45.5) of overall CRC deaths in this period to nonuse of colonoscopy.
They added that, theoretically, the percentage of CRC deaths prevented by colonoscopy in the U.S. ranged from 29% (95% CI, 23.4-33.6) between 2008 and 2009 to 33.9% (95% CI, 27.4-39.2) between 2010 and 2011, compared with 30.7% (95% CI, 24.8-35.7) in Germany.
“Our findings confirm the values of [attributable fraction] and [prevented fraction] metrics in evaluating the public health impacts of colonoscopy in screening settings, which can serve as evidence in the development and prioritization of intervention programs and strategies regarding endoscopic CRC screening,” the researchers concluded. – by Adam Leitenberger
Disclosures: Healio Gastroenterology was unable to confirm the researchers’ relevant financial disclosures at the time of publication.