Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 1;13(4):e00479.
doi: 10.14309/ctg.0000000000000479.

Screening Colonoscopy Findings Are Associated With Noncolorectal Cancer Mortality

Brian A Sullivan  1   2 , Xuejun Qin  1   2 , Cameron Miller  1   2 , Elizabeth R Hauser  1   2 , Thomas S Redding 4th  1 , Ziad F Gellad  1   2 , Ashton N Madison  1 , Laura W Musselwhite  1   3 , Jimmy T Efird  1 , Kellie J Sims  1 , Christina D Williams  1   2 , David Weiss  4 , David Lieberman  5   6 , Dawn Provenzale  1   2
Affiliations

Screening Colonoscopy Findings Are Associated With Noncolorectal Cancer Mortality

Brian A Sullivan et al. Clin Transl Gastroenterol. .

Abstract

Introduction: Controversy exists regarding the impact of various risk factors on noncolorectal cancer (CRC) mortality in healthy screening populations. We examined the impact of known CRC risk factors, including baseline colonoscopy findings, on non-CRC mortality in a screening population.

Methods: Cooperative Studies Program (CSP) #380 is comprised of 3,121 veterans aged 50-75 years who underwent screening colonoscopy from 1994 to 97 and were then followed for at least 10 years or until death. Hazard ratios (HRs) for risk factors on non-CRC mortality were estimated by multivariate Cox proportional hazards.

Results: 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).

Discussion: In a CRC screening population, known modifiable risk factors were significantly associated with 10-year non-CRC mortality. 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.

PubMed Disclaimer

Conflict of interest statement

Guarantor of the article: Brian A. Sullivan, MD, MHS.

Specific author contributions: B.A.S., D.P., E.R.H., and Z.F.G.: study concept and design. B.A.S., X.Q., T.S.R., L.M., K.J.S., and A.M.: acquisition of data. B.A.S., X.Q., C.D.M., K.J.S., T.S.R., E.R.H., and D.P.: analysis and interpretation of data. B.S., E.R.H., Z.F.G., and D.P.: drafting of the manuscript. J.T.E., K.J.S., C.D.W., L.W.M., D.W., and D.L.: critical revision of the manuscript for important intellectual content. X.Q., C.M., T.S.R., and E.R.H.: statistical analysis. E.R.H., D.L., and D.P.: obtained funding. A.M.: administrative, technical, or material support. E.R.H., D.L., and D.P.: study supervision.

Financial support: This work was funded by the US Department of Veteran Affairs Cooperative Studies Program.

Potential competing interests: B.A.S. reports grant support from Exact Sciences, which is outside the submitted work. D.L. reports other support from Check-Cap, Ironwood, ColoWrap, and Freenome, which is outside the submitted work. No other authors have anything to disclose. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the government of the United States.

Data availability: Analysis code is available on reasonable request (https://www.vacsp.research.va.gov/CSPEC/Studies/INVESTD-R/CSP-380-Risk-Factor-Colonic-Adenomas.asp).

References

    1. Leading Causes of Death. Mortality in the United States, 2019. (https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm). Accessed March 4, 2021.
    1. Anderson AS, Craigie AM, Caswell S, et al. The impact of a bodyweight and physical activity intervention (BeWEL) initiated through a national colorectal cancer screening programme: Randomised controlled trial. BMJ 2014;348:g1823. - PMC - PubMed
    1. Helander S, Heinavaara S, Sarkeala T, et al. Lifestyle in population-based colorectal cancer screening over 2-year follow-up. Eur J Public Health 2018;28(2):333–8. - PubMed
    1. Knudsen MD, Hjartaker A, Olsen MKE, et al. Changes in health behavior 1 year after testing negative at a colorectal cancer screening: A randomized-controlled study. Eur J Cancer Prev 2018;27(4):316–22. - PubMed
    1. Larsen IK, Grotmol T, Almendingen K, et al. Impact of colorectal cancer screening on future lifestyle choices: A three-year randomized controlled trial. Clin Gastroenterol Hepatol 2007;5(4):477–83. - PubMed

Publication types