Effects of organized colorectal cancer screening on cancer incidence and mortality in a large community-based population Journal Article


Authors: Levin, T. R.; Corley, D. A.; Jensen, C. D.; Schottinger, J. E.; Quinn, V. P.; Zauber, A. G.; Lee, J. K.; Zhao, W. K.; Udaltsova, N.; Ghai, N. R.; Lee, A. T.; Quesenberry, C. P.; Fireman, B. H.; Doubeni, C. A.
Article Title: Effects of organized colorectal cancer screening on cancer incidence and mortality in a large community-based population
Abstract: Background & Aims: Little information is available on the effectiveness of organized colorectal cancer (CRC) screening on screening uptake, incidence, and mortality in community-based populations. Methods: We contrasted screening rates, age-adjusted annual CRC incidence, and incidence-based mortality rates before (baseline year 2000) and after (through 2015) implementation of organized screening outreach, from 2007 through 2008 (primarily annual fecal immunochemical testing and colonoscopy), in a large community-based population. Among screening-eligible individuals 51–75 years old, we calculated annual up-to-date status for cancer screening (by fecal test, sigmoidoscopy, or colonoscopy), CRC incidence, cancer stage distributions, and incidence-based mortality. Results: Initiation of organized CRC screening significantly increased the up-to-date status of screening, from 38.9% in 2000 to 82.7% in 2015 (P <.01). Higher rates of screening were associated with a 25.5% reduction in annual CRC incidence between 2000 and 2015, from 95.8 to 71.4 cases/100,000 (P <.01), and a 52.4% reduction in cancer mortality, from 30.9 to 14.7 deaths/100,000 (P <.01). Increased screening was initially associated with increased CRC incidence, due largely to greater detection of early-stage cancers, followed by decreases in cancer incidence. Advanced-stage CRC incidence rates decreased 36.2%, from 45.9 to 29.3 cases/100,000 (P <.01), and early-stage CRC incidence rates decreased 14.5%, from 48.2 to 41.2 cases/100,000 (P <.04). Conclusions: Implementing an organized CRC screening program in a large community-based population rapidly increased screening participation to the ≥80% target set by national organizations. Screening rates were sustainable and associated with substantial decreases in CRC incidence and mortality within short time intervals, consistent with early detection and cancer prevention. © 2018 AGA Institute
Keywords: adult; aged; middle aged; major clinical study; cancer staging; cancer diagnosis; cancer incidence; neoplasm; colorectal cancer; cancer screening; cancer mortality; population research; colonoscopy; colon cancer; sigmoidoscopy; early detection; mortality rate; occult blood test; fit; human; female; priority journal; article
Journal Title: Gastroenterology
Volume: 155
Issue: 5
ISSN: 0016-5085
Publisher: Elsevier Inc.  
Date Published: 2018-11-01
Start Page: 1383
End Page: 1391.e5
Language: English
DOI: 10.1053/j.gastro.2018.07.017
PUBMED: 30031768
PROVIDER: scopus
PMCID: PMC6240353
DOI/URL:
Notes: Article -- Export Date: 3 December 2018 -- Source: Scopus
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  1. Ann G Zauber
    300 Zauber