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Long-Term Mortality after Screening for Colorectal Cancer — NEJM
Original Article
Long-Term Mortality after Screening for Colorectal Cancer
Aasma Shaukat, M.D., M.P.H., Steven J. Mongin, M.S., Mindy S. Geisser, M.S., Frank A. Lederle, M.D., John H. Bond, M.D., Jack S. Mandel, Ph.D., M.P.H., and Timothy R. Church, Ph.D.
- Abstract
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Background
In randomized trials, fecal occult-blood testing reduces mortality from colorectal cancer. However, the duration of the benefit is unknown, as are the effects specific to age and sex.
Methods
In the Minnesota Colon Cancer Control Study, 46,551 participants, 50 to 80 years of age, were randomly assigned to usual care (control) or to annual or biennial screening with fecal occult-blood testing. Screening was performed from 1976 through 1982 and from 1986 through 1992. We used the National Death Index to obtain updated information on the vital status of participants and to determine causes of death through 2008.
Results
Through 30 years of follow-up, 33,020 participants (70.9%) died. A total of 732 deaths were attributed to colorectal cancer: 200 of the 11,072 deaths (1.8%) in the annual-screening group, 237 of the 11,004 deaths (2.2%) in the biennial-screening group, and 295 of the 10,944 deaths (2.7%) in the control group. Screening reduced colorectal-cancer mortality (relative risk with annual screening, 0.68; 95% confidence interval [CI], 0.56 to 0.82; relative risk with biennial screening, 0.78; 95% CI, 0.65 to 0.93) through 30 years of follow-up. No reduction was observed in all-cause mortality (relative risk with annual screening, 1.00; 95% CI, 0.99 to 1.01; relative risk with biennial screening, 0.99; 95% CI, 0.98 to 1.01). The reduction in colorectal-cancer mortality was larger for men than for women in the biennial-screening group (P=0.04 for interaction).
Conclusions
The effect of screening with fecal occult-blood testing on colorectal-cancer mortality persists after 30 years but does not influence all-cause mortality. The sustained reduction in colorectal-cancer mortality supports the effect of polypectomy. (Funded by the Veterans Affairs Merit Review Award Program and others.)
Estimates from multiple, large, randomized trials of colorectal-cancer screening with fecal occult-blood testing consistently show a reduction in colorectal-cancer mortality of 15 to 33%.
1-4 The longest follow-up reported to date is 18 to 20 years.
5-7 Whether the effect of screening on colorectal-cancer mortality is sustained and whether it applies to all age groups and both sexes are unknown. Furthermore, none of the trials have shown a reduction in all-cause mortality, and one meta-analysis showed a significant increase in mortality not related to colorectal cancer.
8 We updated the Minnesota Colon Cancer Control Study
9 through 30 years of follow-up to assess the long-term effect of screening on colorectal-cancer mortality and all-cause mortality and to evaluate effects specific to age and sex.
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