In 2002, Germany was one of the first countries worldwide to introduce colonoscopy as part of its national statutory cancer screening program. Scientists from the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) have now looked back on the first ten years of this program to evaluate its effectiveness: how many cases of cancer did it prevent? How many tumors were detected early in the course of the disease? And what about cases of over-diagnosis, where the method indicated a malignancy that would not have become clinically significant during a person’s lifetime?
In the current study, the researchers evaluated the medical reports of 4.4 million screening colonoscopies conducted between 2003 and 2012. “This is the most comprehensive evaluation of a[s1] national screening colonoscopy program to date,” says study head Prof. Hermann Brenner of the DKFZ, who was in charge of the study.
The calculations are based on a mathematical model that takes into account not only medical reports and mortality rates, but also other factors such as the incidence of different types of precancerous lesions and the course of time over which they turn into colorectal cancer.
During these first ten years of endoscopic gastrointestinal screening, a total of 180,000 precancerous lesions were discovered and immediately removed during the examination. Additionally, physicians found over 40,000 cases of early-stage colorectal cancer, a phase in which the disease is still curable in most cases. In contrast, there were only about 4,500 cases of over-diagnosis.
“In about one out of 28 colonoscopy examinations, a physician finds a precancerous lesion and thus prevents a cancer case,” says Dr. Michael Hoffmeister, one of the authors of the publication. “In one out of 121 examinations, doctors detect a malignant tumor early on. But only one out of 1,089 examinations leads to an over-diagnosis.” He adds: “In participants under 75 years of age, only 0.4 percent of gastrointestinal endoscopic exams result in an over-diagnosis. This means that colonoscopy screening produces significantly better results than other cancer screening programs. Mammography, for example, has a much higher over-diagnosis rate.”
Endoscopic examinations have the highest chance of preventing a case of cancer if conducted at around the age of 60 years. Increasing age of the subjects is accompanied by a rise in the rate of over-diagnosis.
Brenner’s conclusion is crystal clear: “In the long term, colonoscopy will lower colorectal cancer mortality. Moreover, endoscopic screening is a real means of prevention. As opposed to other screening programs, it will also significantly lower the incidence of new cancer cases.”
Hermann Brenner, Lutz Altenhofen, Christian Stock, Michael Hoffmeister: Prevention, Early Detection, and Overdiagnosis of Colorectal Cancer Within 10 Years of Screening Colonoscopy in Germany. Clinical Gastroenterology and Hepatology 2014, DOI: 10.1016/j.cgh.2014.08.036
The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) with its more than 3,000 employees is the largest biomedical research institute in Germany. At DKFZ, more than 1,000 scientists investigate how cancer develops, identify cancer risk factors and endeavor to find new strategies to prevent people from getting cancer. They develop novel approaches to make tumor diagnosis more precise and treatment of cancer patients more successful. The staff of the Cancer Information Service (KID) offers information about the widespread disease of cancer for patients, their families, and the general public. Jointly with Heidelberg University Hospital, DKFZ has established the National Center for Tumor Diseases (NCT) Heidelberg, where promising approaches from cancer research are translated into the clinic. In the German Consortium for Translational Cancer Research (DKTK), one of six German Centers for Health Research, DKFZ maintains translational centers at seven university partnering sites. Combining excellent university hospitals with high-profile research at a Helmholtz Center is an important contribution to improving the chances of cancer patients. DKFZ is a member of the Helmholtz Association of National Research Centers, with ninety percent of its funding coming from the German Federal Ministry of Education and Research and the remaining ten percent from the State of Baden-Württemberg.