title: Colorectal cancer mortality prevented by use and attributable to nonuse of colonoscopy.
abstract: BACKGROUND
  Use of colonoscopy is thought to reduce colorectal cancer (CRC) mortality, but its impact at the population level is unclear.
  
  
  OBJECTIVE
  To estimate the effect of current colonoscopy use on CRC mortality and its further potential in reducing CRC mortality.
  
  
  METHODS
  Population-level analysis was performed by using the concepts of prevented and attributable fractions, by using data from the National Health Interview Survey, the Surveillance, Epidemiology and End Results Program, and estimates of the effectiveness of colonoscopy at reducing CRC mortality.
  
  
  METHODS
  The 2005 U.S. population aged 50 years and older.
  
  
  METHODS
  Colonoscopy within 10 years or less.
  
  
  METHODS
  Percentages and absolute numbers of CRC deaths prevented and potentially preventable by colonoscopy.
  
  
  CONCLUSIONS
  Uncertainty in effectiveness estimates.
  
  
  RESULTS
  Overall, the proportions of CRC deaths in 2005 prevented by colonoscopy (ie, the prevented fractions) range from 13% (95% CI, 11%-15%) to 19% (95% CI, 12%-24%) across the estimates of colonoscopy effectiveness. Corresponding numbers of CRC deaths prevented range from 7314 (95% CI, 6010-8467) to 11,711 (95% CI, 7077-14,898). The proportions of CRC deaths attributable to nonuse of colonoscopy (ie, the attributable fractions) range from 28% (95% CI, 22%-33%) to 44% (95% CI, 24%-60%), depending on the assumed effectiveness. Corresponding numbers of CRC deaths attributed to nonuse of colonoscopy range from 13,796 (95% CI, 11,076-16,255) to 22,088 (95% CI, 12,189-29,947).
  
  
  CONCLUSIONS
  Although we estimate that colonoscopy has prevented substantial numbers of CRC deaths, many more deaths could have been prevented with more widespread use. These findings highlight the potential benefits from public health interventions to increase the use of screening colonoscopy.
authors.affiliation: German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stock
authors.forename: Amy B
authors.initials: AB
authors.lastname: Knudsen
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.forename: Ulrike
authors.initials: U
authors.lastname: Haug
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology