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.
- 1. Australian Institute of Health and Welfare. Australian Cancer Incidence and Mortality (ACIM) books. Canberra: AIHW, 2011. http://www.aihw.gov.au/acim-books (accessed Jul 2014).
- 2. Hewitson P, Glasziou P, Irwig L, et al. Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database Syst Rev 2007; (1): CD001216.
- 3. Elmunzer BJ, Hayward RA, Schoenfeld PS, et al. Effect of flexible sigmoidoscopy-based screening on incidence and mortality of colorectal cancer: a systematic review and meta-analysis of randomized controlled trials. PLOS Med 2012; 9: e1001352.
- 4. Australian Institute of Health and Welfare. National Bowel Cancer Screening Program monitoring report: phase 2, July 2008 — June 2011. Canberra: AIHW, 2012. (AIHW Cat. No. CAN 62; Cancer Series No. 66.) http://www.aihw.gov.au/publication-detail/?id=10737421408 (accessed Jul 2014).
- 5. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008; 134: 1570-1595.
- 6. von Karsa L, Anttila A, Ronco G, et al. Cancer screening in the European Union. Report on the implementation of the Council Recommendation on cancer screening. Lyon: International Agency for Research on Cancer, 2008. http://ec.europa.eu/health/ph_determinants/genetics/documents/cancer_screening.pdf (accessed Jul 2014).
- 7. Australian Cancer Network Colorectal Cancer Guidelines Revision Committee. Guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia and Australian Cancer Network, 2005. http://www.nhmrc.gov.au/guidelines/publications/cp106 (accessed Jul 2014).
- 8. Ananda SS, McLaughlin SJ, Chen F, et al. Initial impact of Australia's National Bowel Cancer Screening Program. Med J Aust 2009; 191: 378-381. <MJA full text>
- 9. Cole SR, Tucker GR, Osborne JM, et al. Shift to earlier stage at diagnosis as a consequence of the National Bowel Cancer Screening Program. Med J Aust 2013; 198: 327-330. <MJA full text>
- 10. Kavanagh AM, Giovannucci EL, Fuchs CS, Colditz GA. Screening endoscopy and risk of colorectal cancer in United States men. Cancer Causes Control 1998; 9: 455-462.
- 11. Nishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369: 1095-1105.
- 12. 45 and Up Study Collaborators, Banks E, Redman S, et al. Cohort profile: the 45 and Up Study. Int J Epidemiol 2008; 37: 941-947.
- 13. Sax Institute. 45 and Up Study technical note 1: Missing or invalid values. 2013. https://www.saxinstitute.org.au/wp-content/uploads/Technical-Note-missing-or-invalid-values.pdf (accessed Jun 2014).
- 14. Sax Institute. The baseline questionnaire. https://www.saxinstitute.org.au/our-work/45-up-study/questionnaires (accessed Jun 2014).
- 15. Kemp A, Preen DB, Saunders C, et al. Ascertaining invasive breast cancer cases; the validity of administrative and self-reported data sources in Australia. BMC Med Res Methodol 2013; 13: 17.
- 16. Goldsbury DE, Armstrong K, Simonella L, et al. Using administrative health data to describe colorectal and lung cancer care in New South Wales, Australia: a validation study. BMC Health Serv Res 2012; 12: 387.
- 17. Sterne JA, White IR, Carlin JB, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 2009; 338: b2393.
- 18. Hewitson P, Glasziou P, Watson E, et al. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (Hemoccult): an update. Am J Gastroenterol 2008; 103: 1541-1549.
- 19. Kronborg O, Jørgensen OD, Fenger C, Rasmussen M. Randomized study of biennial screening with a faecal occult blood test: results after nine screening rounds. Scand J Gastroenterol 2004; 39: 846-851.
- 20. Bretthauer M, Kalager M. Principles, effectiveness and caveats in screening for cancer. Br J Surg 2013; 100: 55-65.
- 21. Brenner H, Hoffmeister M, Arndt V, et al. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst 2010; 102: 89-95.
- 22. Cotterchio M, Manno M, Klar N, et al. Colorectal screening is associated with reduced colorectal cancer risk: a case–control study within the population-based Ontario Familial Colorectal Cancer Registry. Cancer Causes Control 2005; 16: 865-875.
- 23. Lieberman DA. Clinical practice. Screening for colorectal cancer. N Engl J Med 2009; 361: 1179-1187.
- 24. Kaminski MF, Bretthauer M, Zauber AG, et al. The NordICC Study: rationale and design of a randomized trial on colonoscopy screening for colorectal cancer. Endoscopy 2012; 44: 695-702.
- 25. Quintero E, Castells A, Bujanda L, et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med 2012; 366: 697-706.
- 26. Haug U, Knudsen AB, Brenner H, Kuntz KM. Is fecal occult blood testing more sensitive for left- versus right-sided colorectal neoplasia? A systematic literature review. Expert Rev Mol Diagn 2011; 11: 605-616.
- 27. Whitlock EP, Lin J, Liles E, et al. Screening for colorectal cancer: an updated systematic review. Rockville, Md: Agency for Healthcare Research and Quality, 2008.
- 28. Brenner H, Arndt V, Stürmer T, et al. Long-lasting reduction of risk of colorectal cancer following screening endoscopy. Br J Cancer 2001; 85: 972-976.
- 29. Newcomb PA, Storer BE, Morimoto LM, et al. Long-term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidence. J Natl Cancer Inst 2003; 95: 622-625.
- 30. Rauscher GH, Johnson TP, Cho YI, Walk JA. Accuracy of self-reported cancer-screening histories: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2008; 17: 748-757.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.