The number of deaths that could have occurred from colorectal cancer (CRC) in Germany and the US in recent years likely was reduced by as much as one third through use of colonoscopy, and many more deaths could be avoided by increasing colonoscopy use in the target population, according to “Public health impact of colonoscopy use on colorectal cancer mortality in Germany and the United States,” published in the January issue
of GIE: Gastrointestinal Endoscopy
, the journal of the American Society for Gastrointestinal Endoscopy.
Colorectal cancer is the third most commonly diagnosed cancer worldwide and a significant cause of cancer deaths in the US and Europe. Because screening can detect precancerous lesions and early cancerous lesions well before they progress to invasive cancer, substantial portions of these deaths could be prevented with screening.
Colonoscopy has been proven effective in reducing colorectal cancer (CRC) incidence and mortality and has been widely used for primary CRC screening in Germany and the United States. The study looked at aggregate data on colonoscopy effectiveness and utilization, as well as CRC incidence and mortality, among adults aged 55 to 79 years in Germany and the US from 2008 to 2011.
The study perspective was that some deaths were presumably prevented
of colonoscopy, and other actual deaths could have been prevented
if colonoscopy were used more widely.
They applied the epidemiological metrics of “prevented fraction” to determine deaths that were actually prevented through colonoscopy, and “attributable fraction” to determine deaths that could be attributed to non-use
of colonoscopy In this way, they endeavored to present a picture of the true potential public health impact of this procedure.
Overall, 36.6% of CRC deaths in Germany were estimated to be attributable to nonuse of colonoscopy, compared with the U.S. estimates of 38.2% and 33.6% for years 2008 to 2009 and 2010 to 2011, respectively. The proportion of CRC deaths theoretically prevented by colonoscopy use within 10 years was 30.7% in Germany, whereas in the United States this proportion ranged from 29.0% for 2008 to 2009 to 33.9% (for 2010 to 2011).
The researchers concluded that colonoscopy use likely reduced by up to one-third the number of colorectal cancer (CRC) deaths in both the US and Germany, and many more deaths could be avoided by increasing colonoscopy use in the target population. According to the authors, attributable and prevented fraction can provide valuable information on the public health impact of colonoscopy use and guide policymaking.