多做大腸鏡，降低大腸癌死亡率嗎?


又是一個從加拿大健保資料庫出來的paper
自1993追到2006年底，colonoscope的執行增加了四倍
每增加1%, 減少大腸癌死亡 3%

這是一個統計數字的把戲嗎?
editorial認為文章沒有把其它降低大腸癌發生率的因子統計進去
美國的study也證明大腸癌的死亡率一直降，even before colonoscope



Colonoscopy Use Associated with Reduction in Colorectal Cancer Mortality

Long-term follow-up data showed a 3% decrease in the risk for death from CRC for every 1% increase in the colonoscopy rate.

Evidence that colonoscopy use reduces the incidence of colorectal cancer (CRC), presumably through polypectomy, comes primarily from fecal occult blood testing trials. No randomized controlled trials testing whether colonoscopy use prevents CRC have been performed.

In one of several ongoing studies on colonoscopy from Ontario, Canada, investigators analyzed colonoscopy rates and CRC incidence and mortality through December 2006 for all people aged 50 to 90 who had been residents of Ontario on January 1, 1993. During the 14 years of follow-up, the overall colonoscopy rate increased roughly fourfold, with increases evident in all regions of the province. For every 1% increase in the overall colonoscopy rate, the hazard ratio for death from CRC decreased by 3%.

Comment: This study adds to several lines of indirect evidence that colonoscopy use is associated with reductions in CRC mortality. Whether it leads to reductions specifically in the incidence of proximal colon cancer remains unclear. As noted in an accompanying editorial, the study design does not allow other potential contributors to the reduction in cancer incidence to be excluded. These include reduction in risk factors or improvements in treatment, which might also have shown regional variation.

— Douglas K. Rex, MD

Published in Journal Watch Gastroenterology August 13, 2010
Citation(s):

Rabeneck L et al. Association between colonoscopy rates and colorectal cancer mortality. Am J Gastroenterol 2010 Jul; 105:1627.

* Medline abstract (Free)

Sandler RS. Colonoscopy and colorectal cancer mortality: Strong beliefs or strong facts? Am J Gastroenterol 2010 Jul; 105:1633.

* Medline abstract (Free)

https://docs.google.com/fileview?id=0B278nGJMQBk7Nzk4NTdhYTQtMzAyMi00ZTFlLTliNzMtYTI5MTQyNzQ1ODVh&hl=zh_TW

https://docs.google.com/fileview?id=0B278nGJMQBk7OGYxZWUwZTMtNmVkZS00MWJmLTk1MDYtOTdkNjFkZWVjZWNj&hl=zh_TW

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