title: Prevalence of colorectal cancer and its precursor lesions in symptomatic and asymptomatic patients undergoing total colonoscopy: results of a large prospective, multicenter, controlled endoscopy study.
abstract: BACKGROUND
  Colorectal cancer (CRC) is the second most common cancer in Germany. Screening colonoscopies have been offered in Germany since 2002. However, validation of screening programs for CRC relies on estimates up to date.
  
  
  OBJECTIVE
  The aim of this study was to analyze the influence of the risk factor tumor-suspicious symptoms on the prevalence of CRC and its precursor lesions in patients at least 55 years of age undergoing colonoscopy in comparison with an age-matched and sex-matched control population undergoing screening colonoscopy.
  
  
  METHODS
  Multicenter, prospective, controlled colonoscopy study.
  
  
  METHODS
  Integrated care program of 49 gastroenterological practices in collaboration with a health insurance company and the screening colonoscopy program in Hesse, Germany.
  
  
  METHODS
  In total, 1075 symptomatic and 5375 asymptomatic participants were matched for age and sex (1 : 5) from 1 October 2008 to 30 September 2010.
  
  
  METHODS
  Detection of CRC and its precursor lesions.
  
  
  RESULTS
  Overall, the prevalence of CRC was significantly equivalent in both the symptomatic (n=13/1075, 1.21%) and the control group [n=55/5375, 1.02%, 95% confidence interval (CI) for the difference: [-0.46%, 0.83%], P=0.0002, equivalence test with δ=1.5%], respectively. Advanced adenomas were observed in significantly fewer symptomatic patients (61/1075, 5.67%) compared with 432/5375 matched asymptomatic screening participants (8.03%, 95% CI for the difference: [-3.98%, -0.74%], P=0.0094, difference test). Finally, polyps were found significantly less often in symptomatic patients (n=269/1075, 25.0%) than in matched screening participants (n=1807/5375, 33.6%, 95% CI for the difference: [-11.53%, -5.66%], P<0.0001, difference test).
  
  
  CONCLUSIONS
  The results underline the importance of screening the symptom-free population at least 55 years of age to prevent CRC.
authors.affiliation: First Department of Internal Medicine, Division of Gastroenterology, Johann Wolfgang Goethe-University Hospital, Frankfurt/Main, Germany. blumenstein@em.uni-frankfurt.de
authors.forename: Irina
authors.initials: I
authors.lastname: Blumenstein
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Tacke
authors.forename: Herbert
authors.initials: H
authors.lastname: Bock
authors.forename: Natalie
authors.initials: N
authors.lastname: Filmann
authors.forename: Elena
authors.initials: E
authors.lastname: Lieber
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.forename: Jörg
authors.initials: J
authors.lastname: Trojan
authors.forename: Eva
authors.initials: E
authors.lastname: Herrmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Schröder
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003111:Colonic Polyps / Q000175:diagnosis / Q000453:epidemiology; D003113:Colonoscopy / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000379:methods; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D017678:Sex Distribution