Colorectal cancer screening and subsequent incidence of colorectal cancer: results from the 45 and Up Study

Annika Steffen, Marianne F Weber, David M Roder and Emily Banks
Med J Aust 2014; 201 (9): 523-527. || doi: 10.5694/mja14.00197


Objective: To investigate the association of colorectal cancer (CRC) screening history and subsequent incidence of CRC in New South Wales, Australia.

Design, setting and participants: A total of 196 464 people from NSW recruited to the 45 and Up Study, a large Australian population-based prospective study, by completing a baseline questionnaire distributed from January 2006 to December 2008. Individuals without pre-existing cancer were followed for a mean of 3.78 years (SD, 0.92 years) through linkage to population health datasets.

Main outcome measures: Incidence of CRC; hazard ratio (HR) according to screening history, adjusted for age, sex, body mass index, income, education, remoteness, family history, aspirin use, smoking, diabetes, alcohol use, physical activity and dietary factors.

Results: Overall, 1096 cases of incident CRC accrued (454 proximal colon, 240 distal colon, 349 rectal and 53 unspecified cancers). Ever having undergone CRC screening before baseline was associated with a 44% reduced risk of developing CRC during follow-up (HR, 0.56; 95% CI, 0.49–0.63) compared with never having undergone screening. This effect was more pronounced for those reporting endoscopy (HR, 0.50; 95% CI, 0.43–0.58) than those reporting faecal occult blood testing (FOBT) (HR, 0.61; 95% CI, 0.52–0.72). Associations for all screening exposures were strongest for rectal cancer (HR, 0.35; 95% CI, 0.27–0.45) followed by distal colon cancer (HR, 0.60; 95% CI, 0.46–0.78), while relationships were weaker for cancers of the proximal colon (HR, 0.76; 95% CI, 0.62–0.92).

Conclusion: CRC incidence is lower among individuals with a history of CRC screening, through either FOBT or endoscopy, compared with individuals who have never had CRC screening, lasting for at least 4 years after screening.

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  • Annika Steffen1
  • Marianne F Weber2
  • David M Roder3
  • Emily Banks4

  • 1 School of Population Health, University of South Australia, Adelaide, SA.
  • 2 Cancer Research Unit, Cancer Council NSW, Sydney, NSW.
  • 3 School of Population Health, University of South Australia, Adelaide, SA.
  • 4 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT.


This research was completed using data collected through the 45 and Up Study ( The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council NSW; and partners the National Heart Foundation of Australia (NSW Division); NSW Ministry of Health; beyondblue; Ageing, Disability and Home Care, NSW Family and Community Services; the Australian Red Cross Blood Service; and UnitingCare Ageing. We thank the many thousands of people participating in the 45 and Up Study. We also acknowledge the support of the Centre for Health Record Linkage. Annika Steffen was supported by a scholarship from the DFG (German Research Foundation). Emily Banks is supported by the National Health and Medical Research Council of Australia.

Competing interests: No relevant disclosures.

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