Pre-diagnostic colonoscopies reduce cancer mortality - Results from linked population-based data in South Australia

Ming Li, Ian Olver, Dorothy Keefe, Carol Holden, Dan Worthley, Timothy Price, Christos Karapetis, Caroline Miller, Kathleen Powell, Dianne Buranyi-Trevarton, Kellie Fusco, David Roder

Research output: Contribution to journalArticle

Abstract

Background: To investigate the association between pre-diagnostic colonoscopy and colorectal cancer mortality in South Australia. Methods: Colonoscopy histories were obtained for colorectal cancer patients diagnosed in 2003-2013 using linked Medical Benefits Schedule (MBS) claims, hospital-inpatient and cancer-registry data. Colonoscopy histories included the year of colonoscopy, numbers of examinations, and the time from first colonoscopy to diagnosis. Histories of multiple exposures to colonoscopies, and exposures of greater than a year from initial colonoscopy to diagnosis, were regarded as indicators of screening or surveillance activity. Colonoscopies occurring within one year of diagnosis were regarded as more likely to be a response to cancer symptoms than those occurring > 1 year before diagnosis. Associations between colonoscopy history and post-diagnostic survival were analysed using sub-hazard ratios (SHRs) from competing risk regression adjusted for socio-demographic and cancer characteristics. Results: Having pre-diagnostic colonoscopy was associated with an unadjusted reduction in risk of colorectal cancer death of 17% (SHR: 0.83, 95% CI 0.78-0.89). After adjusting for time period and sociodemographic characteristics, the risk of colorectal cancer death reduced by 17% for one pre-diagnostic colonoscopy examination; 27% for two pre-diagnostic colonoscopy examinations; and 45% for three or more pre-diagnostic colonoscopy examinations. Those with a time of over one year from first colonoscopy in the study window to diagnosis, when compared with less than one year, had a 17% lower risk of colorectal cancer death in this adjusted analysis. These reductions were substantially reduced or eliminated when also adjusting for less advanced stage. Conclusions: Pre-diagnostic colonoscopy, and more so, multiple colonoscopies and first colonoscopy occurring over one year from initial colonoscopy to diagnosis, were associated with longer survival post diagnosis. This was largely explained by less advanced cancer stage at the time of diagnosis.

LanguageEnglish
Article number856
JournalBMC Cancer
Volume19
Issue number1
DOIs
Publication statusPublished - 29 Aug 2019

Keywords

  • Colonoscopy history
  • Colorectal cancer death
  • Competing risk analysis
  • Linked inpatient and medical benefits schedule data
  • South Australia

ASJC Scopus subject areas

  • Genetics
  • Oncology
  • Cancer Research

Cite this

Li, Ming ; Olver, Ian ; Keefe, Dorothy ; Holden, Carol ; Worthley, Dan ; Price, Timothy ; Karapetis, Christos ; Miller, Caroline ; Powell, Kathleen ; Buranyi-Trevarton, Dianne ; Fusco, Kellie ; Roder, David. / Pre-diagnostic colonoscopies reduce cancer mortality - Results from linked population-based data in South Australia. In: BMC Cancer. 2019 ; Vol. 19, No. 1.
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abstract = "Background: To investigate the association between pre-diagnostic colonoscopy and colorectal cancer mortality in South Australia. Methods: Colonoscopy histories were obtained for colorectal cancer patients diagnosed in 2003-2013 using linked Medical Benefits Schedule (MBS) claims, hospital-inpatient and cancer-registry data. Colonoscopy histories included the year of colonoscopy, numbers of examinations, and the time from first colonoscopy to diagnosis. Histories of multiple exposures to colonoscopies, and exposures of greater than a year from initial colonoscopy to diagnosis, were regarded as indicators of screening or surveillance activity. Colonoscopies occurring within one year of diagnosis were regarded as more likely to be a response to cancer symptoms than those occurring > 1 year before diagnosis. Associations between colonoscopy history and post-diagnostic survival were analysed using sub-hazard ratios (SHRs) from competing risk regression adjusted for socio-demographic and cancer characteristics. Results: Having pre-diagnostic colonoscopy was associated with an unadjusted reduction in risk of colorectal cancer death of 17{\%} (SHR: 0.83, 95{\%} CI 0.78-0.89). After adjusting for time period and sociodemographic characteristics, the risk of colorectal cancer death reduced by 17{\%} for one pre-diagnostic colonoscopy examination; 27{\%} for two pre-diagnostic colonoscopy examinations; and 45{\%} for three or more pre-diagnostic colonoscopy examinations. Those with a time of over one year from first colonoscopy in the study window to diagnosis, when compared with less than one year, had a 17{\%} lower risk of colorectal cancer death in this adjusted analysis. These reductions were substantially reduced or eliminated when also adjusting for less advanced stage. Conclusions: Pre-diagnostic colonoscopy, and more so, multiple colonoscopies and first colonoscopy occurring over one year from initial colonoscopy to diagnosis, were associated with longer survival post diagnosis. This was largely explained by less advanced cancer stage at the time of diagnosis.",
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Pre-diagnostic colonoscopies reduce cancer mortality - Results from linked population-based data in South Australia. / Li, Ming; Olver, Ian; Keefe, Dorothy; Holden, Carol; Worthley, Dan; Price, Timothy; Karapetis, Christos; Miller, Caroline; Powell, Kathleen; Buranyi-Trevarton, Dianne; Fusco, Kellie; Roder, David.

In: BMC Cancer, Vol. 19, No. 1, 856, 29.08.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pre-diagnostic colonoscopies reduce cancer mortality - Results from linked population-based data in South Australia

AU - Li, Ming

AU - Olver, Ian

AU - Keefe, Dorothy

AU - Holden, Carol

AU - Worthley, Dan

AU - Price, Timothy

AU - Karapetis, Christos

AU - Miller, Caroline

AU - Powell, Kathleen

AU - Buranyi-Trevarton, Dianne

AU - Fusco, Kellie

AU - Roder, David

PY - 2019/8/29

Y1 - 2019/8/29

N2 - Background: To investigate the association between pre-diagnostic colonoscopy and colorectal cancer mortality in South Australia. Methods: Colonoscopy histories were obtained for colorectal cancer patients diagnosed in 2003-2013 using linked Medical Benefits Schedule (MBS) claims, hospital-inpatient and cancer-registry data. Colonoscopy histories included the year of colonoscopy, numbers of examinations, and the time from first colonoscopy to diagnosis. Histories of multiple exposures to colonoscopies, and exposures of greater than a year from initial colonoscopy to diagnosis, were regarded as indicators of screening or surveillance activity. Colonoscopies occurring within one year of diagnosis were regarded as more likely to be a response to cancer symptoms than those occurring > 1 year before diagnosis. Associations between colonoscopy history and post-diagnostic survival were analysed using sub-hazard ratios (SHRs) from competing risk regression adjusted for socio-demographic and cancer characteristics. Results: Having pre-diagnostic colonoscopy was associated with an unadjusted reduction in risk of colorectal cancer death of 17% (SHR: 0.83, 95% CI 0.78-0.89). After adjusting for time period and sociodemographic characteristics, the risk of colorectal cancer death reduced by 17% for one pre-diagnostic colonoscopy examination; 27% for two pre-diagnostic colonoscopy examinations; and 45% for three or more pre-diagnostic colonoscopy examinations. Those with a time of over one year from first colonoscopy in the study window to diagnosis, when compared with less than one year, had a 17% lower risk of colorectal cancer death in this adjusted analysis. These reductions were substantially reduced or eliminated when also adjusting for less advanced stage. Conclusions: Pre-diagnostic colonoscopy, and more so, multiple colonoscopies and first colonoscopy occurring over one year from initial colonoscopy to diagnosis, were associated with longer survival post diagnosis. This was largely explained by less advanced cancer stage at the time of diagnosis.

AB - Background: To investigate the association between pre-diagnostic colonoscopy and colorectal cancer mortality in South Australia. Methods: Colonoscopy histories were obtained for colorectal cancer patients diagnosed in 2003-2013 using linked Medical Benefits Schedule (MBS) claims, hospital-inpatient and cancer-registry data. Colonoscopy histories included the year of colonoscopy, numbers of examinations, and the time from first colonoscopy to diagnosis. Histories of multiple exposures to colonoscopies, and exposures of greater than a year from initial colonoscopy to diagnosis, were regarded as indicators of screening or surveillance activity. Colonoscopies occurring within one year of diagnosis were regarded as more likely to be a response to cancer symptoms than those occurring > 1 year before diagnosis. Associations between colonoscopy history and post-diagnostic survival were analysed using sub-hazard ratios (SHRs) from competing risk regression adjusted for socio-demographic and cancer characteristics. Results: Having pre-diagnostic colonoscopy was associated with an unadjusted reduction in risk of colorectal cancer death of 17% (SHR: 0.83, 95% CI 0.78-0.89). After adjusting for time period and sociodemographic characteristics, the risk of colorectal cancer death reduced by 17% for one pre-diagnostic colonoscopy examination; 27% for two pre-diagnostic colonoscopy examinations; and 45% for three or more pre-diagnostic colonoscopy examinations. Those with a time of over one year from first colonoscopy in the study window to diagnosis, when compared with less than one year, had a 17% lower risk of colorectal cancer death in this adjusted analysis. These reductions were substantially reduced or eliminated when also adjusting for less advanced stage. Conclusions: Pre-diagnostic colonoscopy, and more so, multiple colonoscopies and first colonoscopy occurring over one year from initial colonoscopy to diagnosis, were associated with longer survival post diagnosis. This was largely explained by less advanced cancer stage at the time of diagnosis.

KW - Colonoscopy history

KW - Colorectal cancer death

KW - Competing risk analysis

KW - Linked inpatient and medical benefits schedule data

KW - South Australia

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U2 - 10.1186/s12885-019-6092-4

DO - 10.1186/s12885-019-6092-4

M3 - Article

VL - 19

JO - BMC cancer

T2 - BMC cancer

JF - BMC cancer

SN - 1471-2407

IS - 1

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ER -