1. Colonoscopy in veterans was associated with reduced mortality from both left and right-sided colorectal cancer.
2. Mortality was reduced by 61% in patients screened by colonoscopy.
Evidence Rating Level: 2 (Good)
Study Rundown: Colorectal cancer (CRC) screening serves as a critical element of CRC prevention and management. To date, colonoscopy remains the gold standard with respect to CRC screening in the United States. Furthermore, it is widely used in the Veterans Affair (VA) health care system. Despite its widespread use in the VA health care system, the impact of colonoscopy screening on CRC mortality within this population is unknown. The authors of this study aimed to evaluate whether colonoscopy was associated with reduced mortality from CRC among veterans. Additionally, they assessed whether the effect of the colonoscopy differed with respect to anatomical location of CRC. Overall, it was observed that CRC screening significantly reduced mortality from CRC among veterans within this study. This study had several limitations. Firstly, it was unable to assess confounding factors, such as physical exercise or body mass index. Furthermore, results from this study may not be generalizable to all patient populations.
In-Depth [case-control]: The authors of this case-control study aimed to evaluate whether colonoscopy screening among veterans reduced CRC mortality rates. In total, 4964 cases, which consisted of veterans aged 52 years or older and diagnosed with CRC between 2002 and 2008, and 19 856 control patients were identified. The authors conducted logistic regression in order to calculate the odds ratios for mortality in patients exposed to colonoscopy. The authors adjusted for several factors, including race and family history of CRC. In general, it was observed that mortality rates were reduced by 61% in those exposed to colonoscopy. Furthermore, colonoscopy was associated with lower rates of mortality from both left and right-sided CRC (OR, 0.28 [CI, 0.24 to 0.32] and OR, 0.54 [CI, 0.47 to 0.63]). The median time between colonoscopy and CRC diagnosis was 43.5 months (range, 6 to 141 months) among the case population. Finally, the sensitivity analyses did not significantly change the results of the study.
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