Cancer Causes & Control

, Volume 9, Issue 4, pp 455–462 | Cite as

Screening endoscopy and risk of colorectal cancer in United States men

  • Charles S. Fuchs
  • Edward L. Giovannucci
  • Graham A. Colditz
  • Anne M. Kavanagh


Objectives: The purpose of this study was to describe the effect of screening endoscopy (sigmoidoscopy or colonoscopy) on colorectal cancer incidence and mortality. Methods: We used data from a prospective cohort study of 24,744 men aged 40 to 75 years in 1986, free from cancer and colon polyps, followed until 1994. The outcomes are diagnosis of colorectal cancer and death from colorectal cancer. Results: Screening endoscopy in 1986-87 was associated with a lower risk of all colorectal cancer (multivariate relative risk [RR]=0.58, 95 percent confidence interval [CI]=0.36-0.96); cancer in the distal colon or rectum (multivariate RR=0.40, CI=0.19-0.84); Dukes stage A&B (multivariate RR=0.66, CI=0.35-1.25); and Dukes stage C&D (multivariate RR=0.50, CI=0.20-1.26) colorectal cancer; and death from colorectal cancer (multivariate RR=0.56, CI=0.20-1.60), after adjusting for age and a wide range of colon cancer risk factors. Screening endoscopy in 1988-87 appeared to provide strong protection against distal stage C&D cancers (age-adjusted RR=0.16, CI=0.02-1.23) but no protection against proximal stage C&D cancers (age-adjusted RR=0.96, CI=0.32-2.91). Conclusions: This study provides strong evidence for a protective effect of screening sigmoidoscopy on colorectal cancer incidence and mortality and supports recommendations for screening sigmoidoscopy as an approach to colon cancer prevention.

Colorectal cancer men screening endoscopy United States 


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  1. 1.
    Selby J, Friedman G, Quesenberry C, Weiss N. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 1992; 326: 653–7.Google Scholar
  2. 2.
    Muller A, Sonnenberg A. Protection by endoscopy against death from colorectal cancer. Arch Intern Med 1995; 155: 1741–8.Google Scholar
  3. 3.
    Newcomb P, Norfleet R, Storer B, Surawicz S, Marcus P. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst 1992; 84: 1572–5.Google Scholar
  4. 4.
    US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd Ed. Baltimore, MD (USA): Williams and Wilkins, 1996.Google Scholar
  5. 5.
    Sasco A, Day N, Walter S. Case-control studies for the evaluation of screening. J Chron Dis 1986; 39: 399–405.Google Scholar
  6. 6.
    Moss SM. Case-control studies of screening. Int J Epidemiol 1991; 20: 1–6.Google Scholar
  7. 7.
    Morrison A. Screening in Chronic Disease. 2nd Ed. New York, NY (USA): Oxford University Press, 1992.Google Scholar
  8. 8.
    Morrison A. Case definition in case-control studies of the efficacy of screening. Am J Epidemiol 1982; 115: 6–8.Google Scholar
  9. 9.
    Friedman D, Dubin N. Case-control evaluation of breast cancer screening efficacy. Am J Epidemiol 1991; 133: 974–84.Google Scholar
  10. 10.
    Connor R, Prorok P, Weed D. The case-control design and the assessment of the efficacy of cancer screening. J Clin Epidemiol 1991; 44: 1215–21.Google Scholar
  11. 11.
    Weiss N. Control definition in case-control studies of the efficacy of screening and diagnostic testing. Am J Epidemiol 1983; 118: 457–60.Google Scholar
  12. 12.
    Weiss N, McKnight B, Stevens N. Approaches to the analysis of case-control studies of the efficacy of screening for cancer. Am J Epidemiol 1992; 135: 817–23.Google Scholar
  13. 13.
    Rhoads G, Mills J. The role of the case-control study in evaluating health interventions: vitamin supplementation and neural tube defects. Am J Epidemiol 1984; 120: 803–6.Google Scholar
  14. 14.
    Cronin K, Weed D, Connor R, Prorok P. Case-control studies of cancer screening: Theory and practice. J Natl Cancer Inst 1998; 90: 498–504.Google Scholar
  15. 15.
    Weiss N. Application of the case-control method in the evaluation of screening. Epidemiol Rev 1994; 16: 102–8.Google Scholar
  16. 16.
    Potter J, Slattery M, Bostick R, Gapstur S. Colon cancer: a review of the epidemiology. Epidemiol Rev 1993; 15: 499–545.Google Scholar
  17. 17.
    Rimm E, Giovannucci E, Willett W, et al. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet 1991; 338: 464–8.Google Scholar
  18. 18.
    Chasen-Taber S, Rimm E, Stampfer M, et al. Reproducibility and validity of a self-administered physical activity questionnaire for male health professionals. Epidemiology 1996; 7: 81–6.Google Scholar
  19. 19.
    Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Willett WC. Aspirin use and the risk of colorectal cancer and adenoma in male health professionals. Ann Intern Med 1994; 121: 241–6.Google Scholar
  20. 20.
    Giovannucci E, Colditz G, Stampfer M, et al. The assessment of alcohol consumption by a simple self-administered questionnaire. Am J Epidemiol 1991; 133: 810–7.Google Scholar
  21. 21.
    Rimm E, Giovannucci E, Stampfer M, Colditz G, Litin L, Willett W. Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol 1992; 135: 1114–26.Google Scholar
  22. 22.
    Kearney J, Giovannucci E, Rimm E, et al. Diet, alcohol, and smoking and the occurrence of hyperplastic polyps of the colon and rectum (United States). Cancer Causes Control 1995; 6: 45–6.Google Scholar
  23. 23.
    Stampfer M, Willett W, Speizer F, et al. Test of the National Death Index. Am J Epidemiol 1984; 119: 837–9.Google Scholar
  24. 24.
    Fuchs C, Giovannucci E, Colditz G, Hunter D, Speizer F, Willett W. A prospective study of family history and the risk of colorectal cancer. N Engl J Med 1994; 331: 1669–74.Google Scholar
  25. 25.
    Giovannucci E, Rimm E, Stampfer M, Colditz G, Ascherio A, Willett W. Aspirin use and risk of colorectal cancer and adenoma in male health professionals. Ann Int Med 1994; 121: 241–6.Google Scholar
  26. 26.
    Rothman K. Modern Epidemiology. Boston, MA (USA): Little Brown and Company; 1986.Google Scholar
  27. 27.
    Cupples L, D’Agostino R, Anderson K, Kannel W. Comparison of baseline and repeated measure covariate techniques in the Framingham Heart Study. Stat Med 1988; 7: 205–18.Google Scholar
  28. 28.
    Giovannucci E, Ascherio A, Rimm E, Colditz G, Stampfer M, Willett W. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med 1995; 122: 327–34.Google Scholar
  29. 29.
    Giovannucci E, Rimm E, Ascherio A, Stampfer M, Colditz G, Willett W. Alcohol, low-methionine-low-folate diets, and risk of colon cancer in men. J Natl Cancer Inst 1995; 87: 265–73.Google Scholar
  30. 30.
    Giovannucci E, Rimm E, Stampfer M, Colditz G, Ascherio A, Willett W. Intake of fat, meat, and fiber in relation to risk of colon cancer in men. Cancer Res 1994; 54: 2390–7.Google Scholar
  31. 31.
    Giovannucci E, Rimm E, Stampfer M, et al. A prospective study of cigarette smoking and risk of colorectal cancer in U.S. men. J Natl Cancer Inst 1994; 86: 183–91.Google Scholar
  32. 32.
    Winawer S, Zauber A, Nah Ho M, et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med 1993; 329: 1977–81.Google Scholar
  33. 33.
    Morson B. The evolution of colorectal carcinoma. Clin Radiol 1984; 35: 424–31.Google Scholar
  34. 34.
    Stryker S, Wolff B, Culp C, Libbe S, Ilstrup D, MacCarty R. Natural history of untreated colonic polyps. Gastroenterology 1987; 93: 1009–113.Google Scholar
  35. 35.
    Gordon N, Hiatt R, Lampert D. Concordance of self reported data and medical record Audit for six cancer screening procedures. J Natl Cancer Inst 1993; 85: 566–70.Google Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Charles S. Fuchs
    • 1
  • Edward L. Giovannucci
    • 1
    • 2
  • Graham A. Colditz
    • 1
    • 2
  • Anne M. Kavanagh
    • 3
  1. 1.Channing Laboratory, Department of MedicineBrigham and Women's Hospital and Harvard Medical SchoolBoston(USA)
  2. 2.Harvard School of Public HealthBoston
  3. 3.Anti-Cancer Council of VictoriaAustralia

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