This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (219)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A Case-Control Study Among Veterans

Astrid D. Müller, MD, MS; Amnon Sonnenberg, MD, MSc

Arch Intern Med. 1995;155(16):1741-1748.

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)

Author Affiliations
From the Division of Gastroenterology, The Medical College of Wisconsin, Milwaukee (Dr Müller), and the Veterans Affairs Medical Center, Albuquerque, NM (Dr Sonnenberg).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

CT Colonography: Coming of Age
Johnson
Am. J. Roentgenol. 2009;193:1239-1242.
ABSTRACT | FULL TEXT  

Effect of Rising Chemotherapy Costs on the Cost Savings of Colorectal Cancer Screening
Lansdorp-Vogelaar et al.
JNCI J Natl Cancer Inst 2009;101:1412-1422.
ABSTRACT | FULL TEXT  

Association of Colonoscopy and Death From Colorectal Cancer
Baxter et al.
ANN INTERN MED 2009;150:1-8.
ABSTRACT | FULL TEXT  

Validity of Self-Reported Endoscopies of the Large Bowel and Implications for Estimates of Colorectal Cancer Risk
Hoffmeister et al.
Am J Epidemiol 2007;166:130-136.
ABSTRACT | FULL TEXT  

Assessing Attitudes Toward Laxative Preparation in Colorectal Cancer Screening and Effects on Future Testing: Potential Receptivity to Computed Tomographic Colonography
Beebe et al.
Mayo Clin Proc. 2007;82:666-671.
ABSTRACT | FULL TEXT  

Potential for Colorectal Cancer Prevention of Sigmoidoscopy Versus Colonoscopy: Population-Based Case Control Study
Brenner et al.
Cancer Epidemiol. Biomarkers Prev. 2007;16:494-499.
ABSTRACT | FULL TEXT  

Relation Between Medicare Screening Reimbursement and Stage at Diagnosis for Older Patients With Colon Cancer
Gross et al.
JAMA 2006;296:2815-2822.
ABSTRACT | FULL TEXT  

Does a negative screening colonoscopy ever need to be repeated?
Brenner et al.
Gut 2006;55:1145-1150.
ABSTRACT | FULL TEXT  

Screening colonoscopy in very elderly patients: prevalence of neoplasia and estimated impact on life expectancy.
Lin et al.
JAMA 2006;295:2357-2365.
ABSTRACT | FULL TEXT  

Patterns of Cancer Incidence, Mortality, and Prevalence Across Five Continents: Defining Priorities to Reduce Cancer Disparities in Different Geographic Regions of the World
Kamangar et al.
JCO 2006;24:2137-2150.
ABSTRACT | FULL TEXT  

A 71-Year-Old Woman Contemplating a Screening Colonoscopy
Taylor
JAMA 2006;295:1161-1167.
FULL TEXT  

Cutting Cost and Increasing Access to Colorectal Cancer Screening: Another Approach to Following the Guidelines
Fisher et al.
Cancer Epidemiol. Biomarkers Prev. 2006;15:108-113.
ABSTRACT | FULL TEXT  

CT Colonography: Where Have We Been and Where Are We Going?
Macari and Bini
Radiology 2005;237:819-833.
ABSTRACT | FULL TEXT  

Narrative Review: Screening for Colorectal Cancer in Patients with a First-Degree Relative with Colonic Neoplasia
Eisen and Weinberg
ANN INTERN MED 2005;143:190-198.
ABSTRACT | FULL TEXT  

Quality in the technical performance of screening flexible sigmoidoscopy: recommendations of an international multi-society task group
Levin et al.
Gut 2005;54:807-813.
ABSTRACT | FULL TEXT  

Colorectal Cancer Prevention
Hawk and Levin
JCO 2005;23:378-391.
ABSTRACT | FULL TEXT  

Underuse of Screening Sigmoidoscopy and Colonoscopy in a Large Cohort of US Adults
Chao et al.
AJPH 2004;94:1775-1781.
ABSTRACT | FULL TEXT  

Results of the first round of a demonstration pilot of screening for colorectal cancer in the United Kingdom
BMJ 2004;329:133.
ABSTRACT | FULL TEXT  

Colorectal Cancer Screening Adherence in a General Population
Yeazel et al.
Cancer Epidemiol. Biomarkers Prev. 2004;13:654-657.
ABSTRACT | FULL TEXT  

Colorectal Polyps and Cancers in Asymptomatic Average-Risk Patients: Evaluation with CT Colonography
Macari et al.
Radiology 2004;230:629-636.
ABSTRACT | FULL TEXT  

Results of Repeat Sigmoidoscopy 3 Years After a Negative Examination
Schoen et al.
JAMA 2003;290:41-48.
ABSTRACT | FULL TEXT  

Sigmoidoscopy Screening Probably Works, but How Well Is Still Unknown
Mandel
JNCI J Natl Cancer Inst 2003;95:571-573.
FULL TEXT  

Colorectal Cancer Screening: Scientific Review
Walsh and Terdiman
JAMA 2003;289:1288-1296.
ABSTRACT | FULL TEXT  

Surgical Implications of Colonoscopy
Huang and Forde
SURG INNOV 2003;10:13-18.
ABSTRACT  

CT Colonography: Digital Subtraction Bowel Cleansing with Mucosal Reconstruction— Initial Observations
Zalis et al.
Radiology 2003;226:911-917.
ABSTRACT | FULL TEXT  

Risk of Perforation After Colonoscopy and Sigmoidoscopy: A Population-Based Study
Gatto et al.
JNCI J Natl Cancer Inst 2003;95:230-236.
ABSTRACT | FULL TEXT  

Effect of Medicare Coverage on Use of Invasive Colorectal Cancer Screening Tests
Ko et al.
Arch Intern Med 2002;162:2581-2586.
ABSTRACT | FULL TEXT  

CT Screening for Colorectal Cancer
Yee
RadioGraphics 2002;22:1525-1531.
FULL TEXT  

Surveillance guidelines after removal of colorectal adenomatous polyps
Atkin and Saunders
Gut 2002;51:v6-9.
FULL TEXT  

Colonoscopy as a Screening Test for Colorectal Cancer in Average-Risk Individuals
Swaroop and Larson
Mayo Clin Proc. 2002;77:951-956.
ABSTRACT  

Colorectal Cancer Screening for Persons at Average Risk
Anderson et al.
JNCI J Natl Cancer Inst 2002;94:1126-1133.
FULL TEXT  

Colorectal Neoplasms: Prospective Comparison of Thin-Section Low-Dose Multi-Detector Row CT Colonography and Conventional Colonoscopy for Detection
Macari et al.
Radiology 2002;224:383-392.
ABSTRACT | FULL TEXT  

Screening for Colorectal Cancer in Adults at Average Risk: A Summary of the Evidence for the U.S. Preventive Services Task Force
Pignone et al.
ANN INTERN MED 2002;137:132-141.
ABSTRACT | FULL TEXT  

Fecal occult blood testing for colorectal cancer: a perspective
Barry
Ann Oncol 2002;13:61-64.
ABSTRACT | FULL TEXT  

Faecal calprotectin and faecal occult blood tests in the diagnosis of colorectal carcinoma and adenoma
Tibble et al.
Gut 2001;49:402-408.
ABSTRACT | FULL TEXT  

Colorectal cancer screening: Recommendation statement from the Canadian Task Force on Preventive Health Care
CMAJ 2001;165:206-208.
FULL TEXT  

Risks, costs, and compliance limit colorectal adenoma surveillance: lessons from a randomised trial
Lund et al.
Gut 2001;49:91-96.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Colonoscopy in Screening for Colorectal Cancer
Sonnenberg et al.
ANN INTERN MED 2000;133:573-584.
ABSTRACT | FULL TEXT  

CT Colonography: The Next Colon Screening Examination?
Johnson and Dachman
Radiology 2000;216:331-341.
ABSTRACT | FULL TEXT  

Double-Contrast Barium Enema for Colorectal Cancer Screening: A Review of the Issues and a Comparison with Other Screening Alternatives
Glick
Am. J. Roentgenol. 2000;174:1529-1537.
FULL TEXT  

Comparison of Time-Efficient CT Colonography with Two-and Three-Dimensional Colonic Evaluation for Detecting Colorectal Polyps
Macari et al.
Am. J. Roentgenol. 2000;174:1543-1549.
ABSTRACT | FULL TEXT  

Endoscopic Colorectal Cancer Screening: a Cost-Saving Analysis
Loeve et al.
JNCI J Natl Cancer Inst 2000;92:557-563.
ABSTRACT | FULL TEXT  

Predicting Advanced Proximal Colonic Neoplasia With Screening Sigmoidoscopy
Levin et al.
JAMA 1999;281:1611-1617.
ABSTRACT | FULL TEXT  

Computed tomography colonography (virtual colonoscopy): a new method for colorectal screening
JOHNSON and AHLQUIST
Gut 1999;44:301-305.
FULL TEXT  

Endoscopy and Colorectal Cancer Mortality
Saussure and Hadengue
Arch Intern Med 1996;156:1895-1895.
ABSTRACT  

Definition of Screening Status in Case-Control Studies of the Efficacy of Endoscopy
Weiss
Arch Intern Med 1996;156:1113-1113.
ABSTRACT  

Colorectal Cancer Protection by Endoscopic and NSAID Combination
Morgan
Arch Intern Med 1996;156:910-910.
ABSTRACT  

Prevention of Colorectal Cancer by Endoscopic Polypectomy
Van Dam
ANN INTERN MED 1995;123:949-950.
FULL TEXT  

ENDOSCOPY PREVENTS DEATH FROM COLORECTAL CANCER
JWatch General 1995;1995:2-2.
FULL TEXT  

Endoscopic Polypectomy Reduces Mortality From Colorectal Cancer
Sampliner and Garewal
Arch Intern Med 1995;155:1711-1712.
ABSTRACT  

Computerized Detection of Colonic Polyps at CT Colonography on the Basis of Volumetric Features: Pilot Study
Yoshida et al.
Radiology 2002;222:327-336.
ABSTRACT | FULL TEXT