Compared to other preventive health screening interventions, adherence to colonoscopy (COL) recommendations is substantially less than that of other interventions. The payoff of reduced risk of colon cancer seems insufficient inducement for patients to undergo the procedural preparation and intervention for many of our patients. Just how big is the payoff?
Loberg investigated the impact on colon cancer mortality of adenoma removal during COL screening. They compared the colon cancer mortality over a 14-year interval (median follow-up, 7.7 years) for persons who had undergone colonoscopic adenoma removal with the colon cancer mortality in the entire adult population of Norway. The primary outcome of the study was the rate of colon cancer mortality as assessed by the Stratified Mortality Ratio (SMR) — the rate of colon cancer deaths in persons with adenomas removed vs the colon cancer death rate in the general adult population.
Based on 383 colon cancer deaths among 40,826 adenoma patients, compared to 398 colon cancer deaths in the general population, the overall SMR (including all classes of adenomas excised) demonstrated a trend toward lower colon cancer mortality (SMR, 0.96; 95% confidence interval, 0.87-1.06).
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