Effectiveness of Screening Colonoscopy to Prevent Colorectal Cancer Among Medicare Beneficiaries Aged 70 to 79 Years: A Prospective Observational Study.
Effectiveness of Screening Colonoscopy to Prevent Colorectal Cancer Among Medicare Beneficiaries Aged 70 to 79 Years: A Prospective Observational Study.
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DOI：
10.7326/m16-0758
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发表时间：
2017-01-03
影响因子：
39.2
通讯作者：
Hernán MA
中科院分区：
文献类型：
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作者：
García-Albéniz X;Hsu J;Bretthauer M;Hernán MA
筛查结肠镜检查的随机对照试验尚未完成，正在进行的试验排除了75岁或以上的受试者。然而，医疗保险计划报销筛查结肠镜检查，没有年龄上限。评价筛查结肠镜检查在70-74岁和75-79岁人群中预防结直肠癌的有效性和安全性。大规模、以人群为基础的前瞻性研究。观察数据被用来模拟一个有两个臂的靶试验：结肠镜检查和不进行筛查。1,355,692名年龄在70-79岁之间的联邦医疗保险个人(2004-2012年)，他们平均有患结直肠癌的风险，他们使用了联邦医疗保险预防服务，并且在过去五年中没有进行过诊断或监测结肠镜检查。结直肠癌的8年风险和不良事件的30天风险。在70~74岁年龄组中，结肠镜检查组和非检查组结直肠癌的8年风险(95%CI)分别为2.19%(2.00，2.37)和2.62%(2.56，2.67)，绝对风险差−为0.42%(−0.24，−0.63)。在75~79岁年龄组中，结肠镜检查组和非检查组结直肠癌的8年风险(95%CI)分别为2.84%(2.54，3.13)和2.97%(2.92，3.03)，风险差−为0.14%(−0.41，0.16)。在70-74岁年龄组中，结肠镜检查组中任何不良事件的超额30天风险为每千人5.6个不良事件(95%可信区间4.4-6.8)，在75-79岁组中每1000个个人中不良事件的超额风险为10.3个不良事件(95%可信区间8.6-11.1)。无法获得特定于结直肠癌的死亡率，但我们研究了结直肠癌发病率和确诊时的分期。我们的研究结果表明，在70-74岁的受益人中，筛查结肠镜检查对预防结直肠癌的益处不大，而在老年受益人中，这一益处较小。不良事件的风险很低，但在老年人中更大。
No randomized controlled trials of screening colonoscopies have been completed, and ongoing trials exclude subjects aged 75 years or older. The Medicare program, however, reimburses screening colonoscopies without an upper age limit. To evaluate the effectiveness and safety of screening colonoscopy to prevent colorectal cancer in individuals aged 70–74 and 75–79. Large-scale, population-based, prospective study. The observational data was used to emulate a target trial with 2 arms: colonoscopy screening and no screening. 1,355,692 Medicare individuals (2004–2012) aged 70–79 at average risk for CRC who used Medicare preventive services and had no previous diagnostic or surveillance colonoscopies in the previous five years. Eight-year risk of CRC and 30-day risk of adverse events. In the 70–74 age group, the 8-year risk of CRC (95% CI) was 2.19% (2.00, 2.37) in the colonoscopy screening arm and 2.62% (2.56, 2.67) in the no screening arm; absolute risk difference −0.42% (−0.24, −0.63). In the 75–79 age group, the 8-year risk of CRC (95% CI) was 2.84% (2.54, 3.13) in the colonoscopy screening arm and 2.97% (2.92, 3.03) in the no screening arm; risk difference −0.14% (−0.41, 0.16). The excess 30-day risk of any adverse event in the colonoscopy arm was 5.6 adverse events per 1,000 individuals (95% CI 4.4–6.8) in the 70–74 age group and 10.3 adverse events per 1,000 individuals (95% CI 8.6–11.1) in the 75–79 group. CRC-specific mortality was not available, but we studied CRC incidence and stage at diagnosis. Our findings suggest a modest benefit of screening colonoscopy for the prevention of CRC in beneficiaries aged 70–74 years, and a smaller benefit in older beneficiaries. The risk of adverse events was low, but greater among older individuals.