Colorectal cancer screening by colonoscopy and trends in disease-specific mortality: a population-based ecological study of 358 German districts
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Screening for colorectal cancer (CRC) by colonoscopy was implemented in Germany in 2002. Although the procedure has proven to be effective in reducing disease-specific mortality in numerous clinical studies, its effect at the population level is unclear. We performed an ecological study at the level of 358 German districts, testing the hypothesis that a higher participation rate in screening colonoscopy is associated with a stronger decline in CRC mortality from 2001 to 2012.
Information on the use of colonoscopy in each district was extracted from settlement data, used for the remuneration of physicians of the ambulant sector from 2008 to 2011. Yearly mortality rates for each district from 2001 to 2012 were derived from the official mortality statistics. A spatial model was fitted, considering other factors which might influence early detection of CRC (fecal occult blood test (FOBT), diagnostic colonoscopy, material and social area deprivation, and rural-urban disparities).
The population-weighted mean annual participation rate during 2008–2011 in screening colonoscopy was 2.0% (range 0.6 to 3.9%). The weighted mean annual percentage change (APC) of CRC mortality was − 2.9% (range − 7.8 to 1.2%). According to the fully adjusted model, a 1% higher annual participation rate in colonoscopy screening was associated with an additional annual change in CRC mortality rate of − 0.34% (p = 0.015). Given an annual 2.0% participation rate, colonoscopy screening attributed 23% to the observed decline.
Our real-world data from Germany provide first evidence that colonoscopy screening for CRC is effective in reducing disease-specific mortality at the population level.
KeywordsColorectal cancer Screening Colonoscopy Mortality Epidemiology
We thank the Central Research Institute of Ambulatory Health Care in Germany for providing data on use of colonoscopy and FOBT and financial support.
We thank Anne Starker (Robert Koch Institute, Berlin) for providing data from the GEDA 2010 Survey and Klaus Kraywinkel (Robert Koch Institute, Berlin), Karla Geiss and Martin Meyer (Cancer Registry of Bavaria), Andrea Eberle and Sabine Luttmann (Cancer Registry of Bremen), Roland Stabenow (Cancer Registry of Berlin and the New Federal States), Stefan Hentschel and Alice Nennecke (Hamburg Cancer Registry), Joachim Kieschke and Eunice Sirri (Cancer Registry of Lower Saxony), Bernd Holleczek (Saarland Cancer Registry), Katharina Emrich (Cancer Registry of Rhineland-Palatinate), Hiltraud Kajueter and Volkmar Mattauch (Cancer Registry of North Rhine-Westphalia), and Anke Richter and Miriam Holzmann (Cancer Registry of Schleswig-Holstein) for providing data on CRC mortality.
This study was funded by the Central Research Institute of Ambulatory Health Care in Germany.
Compliance with ethical standards
This article does not contain any studies with human participants or animals performed by any of the authors.
Conflict of interest
The authors declare that they have no conflict of interest.
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