Gastroenterology

Gastroenterology

Volume 142, Issue 7, June 2012, Pages 1460-1467.e2
Gastroenterology

Original Research
Clinical—Alimentary Tract
Efficacy of a Nationwide Screening Colonoscopy Program for Colorectal Cancer

https://doi.org/10.1053/j.gastro.2012.03.022Get rights and content

Background & Aims

Screening colonoscopy examinations for colorectal cancer are offered in the United States and some European countries. Data on results and adverse effects of screening colonoscopy are limited. In autumn 2002, colonoscopy was introduced as part of a nationwide cancer screening program in Germany; it was offered to the general population for individuals 55 years of age or older. We collected and analyzed data from this program.

Methods

We performed a prospective cross-sectional study, collecting results from 2,821,392 screening colonoscopies performed at more than 2100 practices by highly qualified endoscopists in Germany from January 2003 to December 2008. Data on participation, colorectal adenoma and cancer detection, and complications were collected using standardized documentation forms. The data generated were centrally processed and evaluated.

Results

The cumulative participation rate was 17.2% of eligible women and 15.5% of eligible men 55–74 years old. The adenoma detection rate (ADR) was 19.4%, with a higher rate in men (25.8% vs 16.7% in women). Advanced adenomas were found in 6.4% of patients. Carcinomas were detected in 25,893 subjects (0.9%); most were of an early UICC stage (I, 47.3%; II, 22.3%; III, 20.7%; IV, 9.6%). The ADRs for gastroenterologists and nongastroenterologists were 25.1% and 22.3%, respectively (adjusted odds ratio, 1.18; 95% confidence interval, 1.16–1.21). The overall complication rate was 2.8/1000 colonoscopies, and the rate of serious complications was 0.58/1000 colonoscopies.

Conclusions

A nationwide colonoscopy screening program that uses highly qualified endoscopists can detect a significant number of adenomas and early-stage carcinomas. The ADR for gastroenterologists was higher than for nongastroenterologists.

Section snippets

Inclusion and Exclusion Criteria

To be eligible for colonoscopy screening, patients had to be 55 years of age or older, asymptomatic with respect to colorectal symptoms, and members of statutory health insurance. Patients with symptoms suggestive of CRC or known risk groups for CRC such as familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer are taken care of outside this program and not included in this analysis.

Participating Physicians and Quality Control

Only physicians with specific qualifications (gastroenterologists, colorectal surgeons, or

Results

Data of 2,821,392 nationwide documented screening colonoscopies from January 2003 to December 2008 were available for analysis. The documented screening colonoscopies were performed by more than 2100 office-based physicians throughout Germany. A total of 45% of these physicians were gastroenterologists, 45% internists, and 5% surgeons. In 5% of cases, the speciality of the endoscopist was unknown. A total of 55.6% of all screening subjects were women; the average age was 64.4 (SD, 6.9) years

Discussion

We report here the results of 2,821,392 colonoscopies performed in 6 years in an opportunistic population-based colonoscopy screening program in Germany. Previous studies have been limited by smaller numbers and including only expert centers, thus making it unknown if these results could be transferred to everyday practice. Our cohort includes all screening colonoscopies performed throughout Germany and, to our knowledge, is the largest database on screening colonoscopies worldwide.

There are 2

Acknowledgments

C.P.P. and L.A. contributed equally to this work.

The authors thank all of the endoscopists performing screening colonoscopies who provided the data for analysis and for their cooperation in gathering additional information about their patients.

References (33)

  • M. Betés et al.

    Use of colonoscopy as a primary screening test for colorectal cancer in average risk people

    Am J Gastroenterol

    (2003)
  • J.J. Sung et al.

    Screening for colorectal cancer in Chinese: comparison of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy

    Gastroenterology

    (2003)
  • Y. Ikeda et al.

    Significance of small distal adenoma for detection of proximal neoplasms in the colorectum

    Gastrointest Endosc

    (2000)
  • P. Hewitson et al.

    Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update

    Am J Gastroenterol

    (2008)
  • T.F. Imperiale et al.

    Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population

    N Engl J Med

    (2004)
  • D.A. Ahlquist et al.

    Accuracy of fecal occult blood screening for colorectal neoplasiaA prospective study using Hemoccult and HemoQuant tests

    JAMA

    (1993)

    • Cited by (232)

    View all citing articles on Scopus

    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by the National Association of Statutory Health Insurance Physicians and the Association of Statutory Health Insurance Fund (data registry and monitoring process). The funding sources had no influence on study design, data collection, monitoring, analysis, and interpretation of results or the decision to submit the manuscript for publication. W. Schmiegel has been supported by the PURE research grant of the Federal Estate of North Rhine Westphalia, Germany.

    View full text
    Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.