Impact of 10 Years of Screening Colonoscopy in Germany

Douglas K. Rex, MD

The program has showed success, with cancer prevention and early detection benefits far exceeding overdiagnoses.

In 2002, Germany instituted a national screening colonoscopy program. Between 2003 and 2012, >4.4 million screening colonoscopies were performed on individuals aged 55 to 79. Using data from the program's national registry, researchers assessed the program's effects on prevention, early detection, and overdiagnosis of colorectal cancers.

Using Markov models, 180,000 colorectal cancers (1 per 28 screening colonoscopies) were estimated to have been prevented, and 40,000 colorectal cancers (1 per 121 colonoscopies) were estimated to have been detected early. These benefits occurred almost entirely in persons aged <75 years. Overdiagnosis, defined as cancer detected at screening colonoscopy that would not have become clinically manifest during the patient's lifetime without screening colonoscopy, occurred in approximately 4500 cases (1 per 1089 colonoscopies), and 28% arose from screening colonoscopies in individuals aged >75 years.

Citation(s):

Brenner H et al. Prevention, early detection, and overdiagnosis of colorectal cancer within 10 years of screening colonoscopy in Germany. Clin Gastroenterol Hepatol 2014 Sep 10; [e-pub ahead of print].