Public health impact of colonoscopy use on colorectal cancer mortality in Germany and the United States

Abstract

Background and aims: Colonoscopy has been demonstrated to be effective in reducing colorectal cancer (CRC) incidence and mortality and has been widely used for primary CRC screening in Germany and the United States. We performed a population-based analysis to evaluate and compare the public health impact of recent colonoscopy use on CRC deaths among adults aged 55 to 79 years in Germany and the United States from 2008 to 2011.

Methods: The epidemiologic metrics of attributable fraction and prevented fraction as well as the impact numbers were calculated using colonoscopy utilization data from nationally representative health surveys, relative risk estimates from medical literature, and CRC death registry data.

Results: Overall, 36.6% (95% credible interval [CrI], 27.3%-45.5%) of CRC deaths in Germany were estimated to be attributable to nonuse of colonoscopy, compared with the U.S. estimates of 38.2% (95% CrI, 28.6%-47.1%) and 33.6% (95% CrI, 24.8%-42.2%) for years 2008 to 2009 and 2010 to 2011, respectively. The proportion of CRC deaths theoretically prevented by colonoscopy use within 10 years was 30.7% (95% CrI, 24.8%-35.7%) in Germany, whereas in the United States this proportion ranged from 29.0% (95% CrI, 23.4%-33.6%) for 2008 to 2009 to 33.9% (95% CrI, 27.4%-39.2%) for 2010 to 2011.

Conclusions: Recent colonoscopy use is likely to have prevented a considerable fraction of CRC mortality in both countries, and more deaths could be avoided by increasing colonoscopy use in the target population. Attributable and prevented fraction can provide valuable information on the public health impact of colonoscopy use and guide policymaking.