Brenner Hermann, Chang-Claude Jenny, Seiler Christoph M, Stürmer Til, Hoffmeister Michael
Department of Epidemiology, German Cancer Research Center, Bergheimer Strasse 20, D-69115 Heidelberg, Germany.
Cancer Epidemiol Biomarkers Prev. 2007 Mar;16(3):494-9. doi: 10.1158/1055-9965.EPI-06-0460. Epub 2007 Mar 2.
We aimed to estimate the proportions of colorectal cancer cases that might be prevented by sigmoidoscopy compared with colonoscopy among women and men. In a population-based case control study conducted in Germany, 540 cases with a first diagnosis of primary colorectal cancer and 614 controls matched for age, sex, and county of residence were recruited. A detailed lifetime history of endoscopic examinations of the large bowel was obtained by standardized personal interviews, validated by medical records, and compared between cases and controls, paying particular attention to location of colorectal cancer and sex differences. Overall, 39%, 77%, and 64% of proximal, distal, and total colorectal cancer cases were estimated to be preventable by colonoscopy. The estimated proportion of total colorectal cancer cases preventable by sigmoidoscopy was 45% among both women and men, assuming that sigmoidoscopy reaches the junction of the descending and sigmoid colon only and findings of distal polyps are not followed by colonoscopy. Assuming that sigmoidoscopy reaches the splenic flexure and colonoscopy is done after detection of distal polyps, estimated proportions of total colorectal cancer preventable by sigmoidoscopy increase to 50% and 55% (73% and 91% of total colorectal cancer preventable by primary colonoscopy) among women and men, respectively. We conclude that colonoscopy provides strong protection against colorectal cancer among both women and men. The proportion of this protection achieved by sigmoidoscopy with follow-up colonoscopy in case of distal polyps may be larger than anticipated. Among men, this regimen may be almost as effective as colonoscopy, at least at previous performance levels of colonoscopy.
我们旨在估计与结肠镜检查相比，乙状结肠镜检查可预防的男性和女性结直肠癌病例的比例。在德国进行的一项基于人群的病例对照研究中，招募了540例首次诊断为原发性结直肠癌的病例和614例年龄、性别及居住县相匹配的对照。通过标准化的个人访谈获得了详细的大肠内镜检查终生史，并经病历验证，然后对病例和对照进行比较，特别关注结直肠癌的位置和性别差异。总体而言，估计近端、远端和全部结直肠癌病例中，分别有39%、77%和64%可通过结肠镜检查预防。假设乙状结肠镜检查仅能到达降结肠和乙状结肠交界处，且发现远端息肉后不进行结肠镜检查，那么乙状结肠镜检查可预防的全部结直肠癌病例比例在男性和女性中均为45%。假设乙状结肠镜检查能到达脾曲，且在发现远端息肉后进行结肠镜检查，那么乙状结肠镜检查可预防的全部结直肠癌估计比例在女性和男性中分别增至至50%和55%（占初次结肠镜检查可预防的全部结直肠癌的73%和91%）。我们得出结论，结肠镜检查对男性和女性的结直肠癌均提供了强有力的保护。在发现远端息肉时进行乙状结肠镜检查并后续进行结肠镜检查所实现的这种保护比例可能比预期的要大。在男性中，这种方案可能几乎与结肠镜检查一样有效，至少在结肠镜检查以前的执行水平上是这样。
