DURHAM, NC – Most people undergoing routine colorectal cancer (CRC) screening and surveillance will die from causes other than CRC.
A new study from the Durham, NC, VAMC and Duke University argued that an opportunity to improve health status is being missed by focusing only on cancer screening.
“Given that these individuals have demonstrated adherence and a desire for routine preventative health care, CRC screening is a unique opportunity to augment efforts to help also prevent non–CRC-related poor health outcomes,” the authors pointed out in Clinical and Translational Gastroenterology. “Gastroenterologists could play a role in the overall health of patients, beyond CRC prevention, by providing brief counseling or referrals for any identified factors that may be detrimental to health such as poor diet, inadequate exercise, tobacco use, or other issues (e.g., medication adherence, sleep apnea, mental health, or dental care.)”1
The study noted that the impact of various risk factors on noncolorectal cancer (CRC) mortality in healthy screening populations is controversial. The researchers sought to examine the effect of known CRC risk factors, including baseline colonoscopy findings, on non-CRC mortality in a screening population.
Cooperative Studies Program (CSP) #380 was made up of 3,121 veterans aged 50-75 years who underwent screening colonoscopy from 1994 to 1997 and were then followed for at least 10 years or until death.
Results demonstrated that current smoking (HR 2.12, 95% confidence interval [CI] 1.78-2.52, compared with nonsmokers) and physical activity (HR 0.89, 95% CI 0.84-0.93) were the modifiable factors most associated with non-CRC mortality in CSP#380.
“In addition, compared with no neoplasia at baseline colonoscopy, non-CRC mortality was higher in participants with ≥3 small adenomas (HR 1.43, 95% CI 1.06-1.94), advanced adenomas (HR 1.32, 95% CI 0.99-1.75), and CRC (HR 2.95, 95% CI 0.98-8.85). Those with 1-2 small adenomas were not at increased risk for non-CRC mortality (HR 1.15, 95% CI 0.94-1.4),” the researchers advised.
The report emphasized that known modifiable risk factors were significantly associated with 10-year non-CRC mortality, adding, “Furthermore, those who died from non-CRC causes within 10 years were more likely to have had high-risk findings at baseline colonoscopy. These results suggest that advanced colonoscopy findings may be a risk marker of poor health outcomes. Integrated efforts are needed to motivate healthy lifestyle changes during CRC screening, particularly in those with high-risk colonoscopy findings and unaddressed risk factors.”
The authors wrote that studies investigating the impact of participating in CRC screening on modifying died and lifestyle risk factors have been inconclusive, with those risk factors being unaddressed or even worsening after screening. “This is especially true since controversy exists regarding which clinical and lifestyle factors most impact mortality risk,” they added. “Clarification of the strength of association between known risk factors and non-CRC mortality, specifically in healthy screening populations, is an unmet need that could improve health outcomes by leading to the development of personalized strategies integrated with CRC screening that efficiently prioritize healthy lifestyle interventions most relevant to the individual.”
The researchers concluded that “initial colonoscopy findings may highlight the immediate real-world consequences of (previously uninvestigated) unhealthy lifestyle choices, inform assessments of short-term non-CRC mortality, and motivate clinical decision making regarding optimal health strategies.”
In the healthy CRC screening population, the study found the following to be associated with higher rates of 10-year non-CRC mortality:
- increasing age,
- African American race,
- more medical comorbidities, and
- current smoking.
On the other hand, increased BMI, higher physical activity and a family history of CRC were protective of short-term non-CRC mortality.
“In addition, high-risk findings (≥3 small adenomas, advanced adenoma, and CRC) on baseline colonoscopy are likely to be valuable predictors of increased non-CRC mortality risk within 10 years,” the researchers advised. “To our knowledge, this is the first study to report an association between baseline colonoscopy findings and non-CRC mortality in a prospective screening population.”
- Adams MA, Kurlander JE, Gao Y, Yankey N, Saini SD. Impact of Coronavirus Disease 2019 on Screening Colonoscopy Utilization in a Large Integrated Health System. Gastroenterology. 2022 Jun;162(7):2098-2100.e2. doi: 10.1053/j.gastro.2022.02.034. Epub 2022 Feb 24. PMID: 35219698; PMCID: PMC8867975.
