title: Survival of patients with symptom- and screening-detected colorectal cancer.
abstract: BACKGROUND
  An increasing proportion of colorectal cancer (CRC) patients are diagnosed by screening rather than symptoms.
  
  
  OBJECTIVE
  We aimed to assess and compare prognosis of patients with screen-detected CRC and symptom-detected CRC.
  
  
  METHODS
  Overall and CRC specific mortality over a median follow-up of 4.8 years was assessed according to mode of diagnosis (symptoms, screening colonoscopy, fecal occult blood test [FOBT], other) in a multi-center cohort of 2,450 CRC patients aged 50-79 years recruited in Germany in 2003-2010.
  
  
  RESULTS
  68%, 11% and 10% were detected by symptoms, screening colonoscopy and FOBT, respectively. The screen-detected cancers had a more favorable stage distribution than the symptom-detected cancers (68% versus 50% in stage I or II). Age- and sex adjusted hazard ratios (HRs) of total mortality with 95% confidence intervals (95% CIs) compared to symptom-detected cancers were 0.35 (0.24-0.50) and 0.36 (0.25-0.53) for screening colonoscopy and FOBT detected CRCs, respectively. HRs were only slightly attenuated and remained highly significant after adjustment for stage and multiple other covariates (0.50 (0.34-0.73) and 0.54 (0.37-0.80), respectively). Even stronger associations were seen for CRC specific mortality. Patients with screen-detected stage III CRC had as good CRC specific survival as patients with symptom-detected stage I or II CRC.
  
  
  CONCLUSIONS
  Patients with screen-detected CRC have a very good prognosis far beyond the level explained by their more favorable stage distribution. Mode of detection is an important, easy-to-obtain proxy indicator for favorable diagnosis beyond earlier stage at diagnosis and as such may be useful for risk stratification in treatment decisions.
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.|Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.|German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Lina
authors.initials: L
authors.lastname: Jansen
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ulrich
authors.affiliation: Unit of Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang-Claude
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoffmeister
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000401:mortality; D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009780:Occult Blood; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D015996:Survival Rate
keywords: colonoscopy; colorectal cancer; fecal occult blood test; screening; survival