Cancer Causes & Control

, Volume 16, Issue 7, pp 865–875

Colorectal Screening is Associated with Reduced Colorectal Cancer Risk: A Case–Control Study within the Population-Based Ontario Familial Colorectal Cancer Registry

  • Michelle Cotterchio
  • Michael Manno
  • Neil Klar
  • John McLaughlin
  • Steven Gallinger
Article

Abstract

Objective:

This is the first study to evaluate the association between colonic screening and colorectal cancer risk among Canadians.

Methods:

A case–control study was conducted. Cases were diagnosed with cancer of the colorectum, between 1997 and 2000, aged 20 to 74 years, identified through the population-based Ontario Cancer Registry and recruited by the Ontario Familial Colorectal Cancer Registry. Controls were a sex- and age-matched random sample of the population of Ontario. 971 cases and 1944 controls completed questionnaires (including colorectal screening history and many risk factors). Multivariate logistic regression analysis was used to obtain adjusted odds ratios (OR) estimates.

Results:

Having had a fecal occult blood screen was associated with reduced colorectal cancer risk (OR=0.76; 95% confidence interval (CI): 0.59, 0.97). Having had a screening sigmoidoscopy was associated with a halving of colorectal cancer risk (OR = 0.52; 95% CI: 0.34, 0.80). Having had a screening colonoscopy did not significantly reduce colorectal cancer risk (OR = 0.69; 95% CI: 0.44, 1.07); however, having had either screening endoscopy was associated with a significant reduction in colorectal cancer risk (OR = 0.62; 95% CI: 0.44, 0.87). Findings differed slightly by anatomic sub-site (proximal and distal colorectum).

Conclusions:

We report a reduction in colorectal cancer risk among persons who underwent colorectal cancer screening; in particular, sigmoidoscopy. Findings are of great importance for the prevention of colorectal cancer.

Key words

case–control study colorectal cancer incidence prevention screening. 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. National Cancer Institute of Canada (NCIC) (2003) Canadian Cancer Statistics 2003, Toronto, CanadaGoogle Scholar
  2. McLaughlin JR, Sloan M, Janovjak D (1995) Cancer Survival in Ontario. The Ontario Cancer Treatment and Research FoundationGoogle Scholar
  3. Mandel, JS, Church, TR, Bond, JH,  et al. 2000The effect of fecal occult-blood screening on the incidence of colorectal cancerNEJM34316031607CrossRefPubMedGoogle Scholar
  4. Slattery, ML, Edwards, SL, Ma, KN, Friedman, GD 2000Colon cancer screening, lifestyle, and risk of colon cancerCancer Causes Control11555563CrossRefPubMedGoogle Scholar
  5. Kronborg, O, Fenger, C, Olsen, J, Jorgensen, O, Sondergaard, O 1996Randomised study of screening for colorectal cancer with faecal occult blood testLancet34814671471CrossRefPubMedGoogle Scholar
  6. Mandel, JS, Church, TR, Ederer, F, Bond, JH 1999Colorectal cancer mortality: effectiveness of biennial screening for fecal occult bloodJ Natl Cancer Inst91434437CrossRefPubMedGoogle Scholar
  7. Hardcastle, JD, Chamberlain, JO, Robinson, MH,  et al. 1996Randomised controlled trial for faecal-occult-blood screening for colorectal cancerLancet34814721477CrossRefPubMedGoogle Scholar
  8. Kavanagh, AM, Giovannucci, EL, Fuchs, CS, Colditz, GA 1998Screening endoscopy and risk of colorectal cancer in United States menCancer Causes Control9455462CrossRefPubMedGoogle Scholar
  9. Muller, A, Sonnenberg, A 1995Prevention of colorectal cancer by flexible endoscopy and polypectomy. A case–control study of 32,702 veteransAnn Intern Med12390410PubMedGoogle Scholar
  10. Brenner, H, Arndt, V, Sturmer, T, Stegmaier, C, Ziegler, H, Dhom, G 2001Long lasting reduction of risk of colorectal cancer following screening endoscopyBr J Cancer85972976CrossRefPubMedGoogle Scholar
  11. Newcomb, P, Storer, B, Morimoto, L, Templeton, A, Potter, J 2003Long-term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidenceJ Natl Cancer Inst95622625PubMedGoogle Scholar
  12. Thiis-Evensen, E, Hoff, G, Sauar, J,  et al. 1999Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancerTelemark Polyp Study I. Scand J Gastroenterol34414420Google Scholar
  13. Cotterchio, M, McKeown-Eyssen, G, Sutherland, H,  et al. 2000Ontario Familial Colon Cancer Registry: Methods and First Year Response RatesChron Dis Canada218186Google Scholar
  14. International Classification of Diseases.1977Manual of the International Statistical Classification of Disease, Injuries, and Causes of Death, 9th Revision ConferenceWorld Health OrganizationGeneva, SwitzerlandGoogle Scholar
  15. Holowaty, EJ, Lee, G, Dale, D, Chong, N 1994A reabstraction study to estimate the accuracy and completeness of data elements in the Ontario Cancer RegistryAmerican Association of Central Cancer RegistriesNiagara-on-the-Lake, OntarioGoogle Scholar
  16. Vasen, HFA, Mecklin, JP, Khan, PM, Lynch, HT 1991The international collaborative group on HNPCCDis Colon Rectum34424425CrossRefPubMedGoogle Scholar
  17. Easson, A, Cotterchio, M, Dale, D, Holowaty, E, Gallinger, S 2002The accuracy of site specific coding for colorectal cancer in a provincial cancer registryNorth American Association of Cancer Registries MeetingTorontoGoogle Scholar
  18. Schlesselman, JJ 1982Case–control studies. Design, conduct, analysisOxford University PressOxfordGoogle Scholar
  19. Maldonado, G, Greenland, S 1993Simulation study by confounder-selection strategiesAm J Epidemiol138923936PubMedGoogle Scholar
  20. Greenland, S 1989Modeling and variable selection in epidemiologic analysisAm J Public Health79340349PubMedGoogle Scholar
  21. Colditz, G, Atwood, K, Emmons, E, Monson, R, Willett, W,  et al. 2000Harvard Report on Cancer Prevention. Volume 4: Harvard Cancer Risk IndexCancer Causes Control11477488CrossRefPubMedGoogle Scholar
  22. Iacopetta, B 2002Are there two sides to colorectal cancer?Int J Cancer101403408CrossRefPubMedGoogle Scholar
  23. Distler, P, Holt, P 1997Are right- and left-sided colon neoplasms distinct tumors?Dig Dis15302311PubMedGoogle Scholar
  24. Bressler, B, Paszat, L, Vinden, C, Li, C, He, J, Rabeneck, L 2004Colonoscopic miss rates for right-sided colon cancer: a population-based analysisGastroenterol127452456CrossRefGoogle Scholar
  25. Winawer, S, Zauber, A, Ho, M,  et al. 1993Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study WorkgroupN Engl J Med329197781CrossRefPubMedGoogle Scholar
  26. Slattery, M, Edwards, S, Samowitz, W 1998Stage of colon cancer at diagnosis: implications for risk factor associations?Int J Epidemiol27382387CrossRefPubMedGoogle Scholar
  27. Baier, M, Calonge, N, Cutter, G,  et al. 2000Validity of self-reported colorectal cancer screening behaviorCancer Epidemiol Biomarkers Prev9229232PubMedGoogle Scholar
  28. Madlensky, L, McLaughlin, J, Goel, V 2003A comparison of self-reported colorectal cancer screening with medical recordsCancer Epidemiol Biomarkers Prev12656659PubMedGoogle Scholar
  29. Colorectal Cancer Screening: Recommendation statement from the Canadian Task Force on Preventative Health Care. (2001) Can Med Assoc J 165: 206–208Google Scholar
  30. Smith, RA, Cokkinidess, V, Eyre, HJ 2004American Cancer Society guidelines for the early detection of cancer, 2004CA Cancer J Clin544152PubMedGoogle Scholar
  31. Institute of Clinical Evaluative Sciences (ICES). (2004) Vinden C, Schultz S, Rabeneck L. Use of Large Bowel Procedures in OntarioGoogle Scholar
  32. Rabeneck, L, Paszat, L 2004A population-based estimate of the extent of colorectal cancer screening in OntarioAm J Gastroenterol9911411144CrossRefPubMedGoogle Scholar
  33. Centers for Disease Control and Prevention (CDC) (2001) Trends in Screening for colorectal cancer-United States, 1997 and 1999. JAMA 285: 1570–1571Google Scholar
  34. Centers for Disease Control and Prevention (CDC) (2003) Colorectal cancer test use among persons aged >50 years-United States, 2001. Morbidity and Mortality Weekly Report. March 14, 52(1): 193–196Google Scholar
  35. Anderson, FA, Guyton, KZ, Hiatt, , RA, , Vernon, SW, Levin, B, Hawk, E 2002Colorectal Cancer Screening for Persons at Average RiskJ Natl Cancer Inst9411261133PubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Michelle Cotterchio
    • 1
    • 2
  • Michael Manno
    • 3
  • Neil Klar
    • 1
    • 2
  • John McLaughlin
    • 2
    • 3
  • Steven Gallinger
    • 3
  1. 1.Division of Preventive OncologyCancer Care OntarioOntarioCanada
  2. 2.Department of Public Health SciencesUniversity of TorontoOnt.Canada
  3. 3.Samuel Lunenfeld Research InstituteMount Sinai HospitalOnt.Canada

Personalised recommendations