title: Improved survival of patients with colon cancer detected by screening colonoscopy.
abstract: BACKGROUND
  Screening for colon cancer (CC) may not only reduce its occurrence but has also the potential to reduce the overall mortality. So far, there has been little evidence that detection of colon cancer by screening colonoscopy results in different survival rates compared to symptomatic patients.
  
  
  METHODS
  Clinical, histological, diagnostic, and survival data of 1016 consecutive patients with CC from a prospectively expanded single-institutional database were analyzed for diagnostic, treatment, and prognostic factors. Findings were then stratified according to detection by screening colonoscopy vs. patients who became symptomatic prior to further diagnostic work-up.
  
  
  RESULTS
  7.1 % of all patients were identified by screening colonoscopy for colon cancer. Screened patients were younger (68.2 vs. 64.8 years), had smaller T stage (p = 0.032), lower tumor stage (p = 0.009), and a tendency to less lymph node metastasis. Overall survival was superior in screened patients, and stage-specific survival showed a tendency to improved survival, which was not statistically significant. Furthermore, a higher percentage of screened patients underwent adjuvant chemotherapy (84.6 vs. 55.0 %, p = 0.032).
  
  
  CONCLUSIONS
  Survival outcome and enrollment in a multimodal treatment was higher in screening-detected patients compared to patients diagnosed after the onset of clinical symptoms. Besides a potential occurrence of lead time bias, these findings strongly support the need for continued improvement of screening programs and the recruitment of more patients for colorectal cancer screening.
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Wuerzburg, Germany. wiegering_a@ukw.de.|Department of Biochemistry and Molecular Biology, University of Wuerzburg, Oberduerrbacherstr. 2, 97074, Wuerzburg, Germany. wiegering_a@ukw.de.|Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, Julius-Maximilian's University, Wuerzburg, Oberduerrbacherstr. 6, 97080, Wuerzburg, Germany. wiegering_a@ukw.de.
authors.forename: Armin
authors.initials: A
authors.lastname: Wiegering
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Wuerzburg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Ackermann
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Wuerzburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Riegel
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Wuerzburg, Germany.
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Dietz
authors.affiliation: Department of Medicine II, Division of Gastroenterology and Hepatology, University Hospital Würzburg, Oberduerrbacherstr. 2, 97074, Wuerzburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Götze
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Wuerzburg, Germany.|Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany.
authors.forename: Christoph-Thomas
authors.initials: CT
authors.lastname: Germer
authors.affiliation: Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Wuerzburg, Germany. klein_i@ukw.de.|Comprehensive Cancer Centre Mainfranken, University Hospital, University of Wuerzburg, Josef-Schneiderstr. 6, 97080, Wuerzburg, Germany. klein_i@ukw.de.|Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, Julius-Maximilian's University, Wuerzburg, Oberduerrbacherstr. 6, 97080, Wuerzburg, Germany. klein_i@ukw.de.
authors.forename: Ingo
authors.initials: I
authors.lastname: Klein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D016019:Survival Analysis; D055815:Young Adult
keywords: Adenoma-carcinoma sequence; Colon cancer; Colonoscopy; Lead time bias; Surgery; Survival