Abstract
Background: Randomized trials have shown that fecal-occult-blood-test (FOBT) and endoscopic exterminations of the large bowel were able to decrease the risk of CRC death. We examined whether changes in CRC mortality in Europe were associated with a history of screening.
Methods: We used data collected as part of the Survey of Health, Aging, and Retirement in Europe (SHARE) project to extract information on exposure to CRC screening in subjects 50 years old or more living in 11 European countries. Distinct data were collected for endoscopy (colonoscopy or sigmoidoscopy) and FOBT. Using the WHO mortality database on causes of deaths, we fitted linear regressions from 1989 to 2010 and calculated changes in mortality for men and women living in each of the 11 countries. We used least square regression and computed R-square statistics (expressed in %) to provide estimates of the association between screening history and changes in CRC mortality.
Results: Over the 22-year period, changes in age-adjusted CRC mortality rates among males/females were -39/-47% in Austria, -34/-32% in France, -30/-44% in Germany, -26/-35% in Switzerland, -17/-23% in Italy, -14/-18% in Denmark, -10/-8% in Sweden, -4/-10% in the Netherlands, +29/-6% in Spain, and +30/+2% in Greece. In males, reports of ever having had an endoscopic examination of the large bowel ranged from 8% in Greece to 35% in Austria. For females, proportions of ever having undergone endoscopic examinations ranged from 8% in Greece to 36% in Austria. FOBT screening over the last 10 years, ranged from 4% in the Netherlands to 61% in Austria for both sexes. In males, a history of one or more endoscopic examination of the large bowel explained 73% of the decrease in CRC mortality. Having had at least one endoscopy or FOBT over the past 10 years explained 54 and 53% of the observed decrease in CRC mortality, respectively. In females, a history of one or more endoscopic examination of the large bowel explained 82% of the decrease in CRC mortality. Having had at least one endoscopy or FOBT over the past 10 years explained 89 and 72% of the decrease, respectively. All R-squares had an associated p value < 0.001.
Conclusions: Changes in CRC mortality are correlated with the level of screening uptake. This provides “real world” evidence of the effectiveness of screening to prevent CRC mortality in the general population and a strong rational for current national CRC screening programs.
Citation Format: Driss Ouakrim, Eva Negri, Matteo Malvezzi, Harry Bleiberg, Mark Jenkins, Mathieu Boniol, Philippe Autier. Trends in colorectal cancer mortality and screening activities in European countries. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C09.
