Colonoscopy and Colorectal Cancer Mortality
Authors: Charles J. Kahi, Heiko Pohl, Laura J. Myers, Douglas J. Robertson, Thomas F. Imperiale
Journal: Annals of Internal Medicine (2018)

Letters18 September 2018Colonoscopy and Colorectal Cancer MortalityCharles J. Kahi, MD, MSc, Heiko Pohl, MD, Laura J. Myers, PhD, Douglas J. Robertson, MD, and Thomas F. Imperiale, MDCharles J. Kahi, MD, MScRichard L. Roudebush VA Medical Center and Indiana University School of Medicine, Indianapolis, Indiana (C.J.K., L.J.M.)Search for more papers by this author, Heiko Pohl, MDVA White River Junction, White River Junction, Vermont (H.P.)Search for more papers by this author, Laura J. Myers, PhDRichard L. Roudebush VA Medical Center and Indiana University School of Medicine, Indianapolis, Indiana (C.J.K., L.J.M.)Search for more papers by this author, Douglas J. Robertson, MDVA Medical Center, White River Junction, Vermont (D.J.R.)Search for more papers by this author, and Thomas F. Imperiale, MDRichard L. Roudebush VA Medical Center, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (T.F.I.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0297 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Drs. Xirasagar and de Groen state that our results may overestimate mortality reduction after exposure to colonoscopy in the Veterans Affairs health system. Although most of the issues they raised were addressed in our article, we will clarify further.Drs. Xirasagar and de Groen contend that colonoscopy status was unreliable because the algorithm used was only 70% sensitive; however, this validated algorithm is used to ascertain colonoscopy indication, not exposure to colonoscopy. The 70% sensitivity could have contributed to misclassification based on indication; thus, the secondary analysis focused on screening colonoscopy but is not relevant to the primary ...References1. Baxter NN, Warren JL, Barrett MJ, Stukel TA, Doria-Rose VP. Association between colonoscopy and colorectal cancer mortality in a US cohort according to site of cancer and colonoscopist specialty. J Clin Oncol. 2012;30:2664-9. [PMID: 22689809] doi:10.1200/JCO.2011.40.4772 CrossrefMedlineGoogle Scholar2. Nishihara R, Wu K, Lochhead P, Morikawa T, Liao X, Qian ZR, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med. 2013;369:1095-105. [PMID: 24047059] doi:10.1056/NEJMoa1301969 CrossrefMedlineGoogle Scholar3. Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150:1-8. [PMID: 19075198] LinkGoogle Scholar4. Singh H, Nugent Z, Demers AA, Kliewer EV, Mahmud SM, Bernstein CN. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology. 2010;139:1128-37. [PMID: 20600026] doi:10.1053/j.gastro.2010.06.052 CrossrefMedlineGoogle Scholar5. Rabeneck L. Endoscopist specialty: a quality indicator at the population level [Editorial]. Clin Gastroenterol Hepatol. 2014;12:93-4. [PMID: 23962545] doi:10.1016/j.cgh.2013.08.009 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Richard L. Roudebush VA Medical Center and Indiana University School of Medicine, Indianapolis, Indiana (C.J.K., L.J.M.)VA White River Junction, White River Junction, Vermont (H.P.)VA Medical Center, White River Junction, Vermont (D.J.R.)Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (T.F.I.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0723. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoColonoscopy and Colorectal Cancer Mortality in the Veterans Affairs Health Care System Charles J. Kahi , Heiko Pohl , Laura J. Myers , Dalia Mobarek , Douglas J. Robertson , and Thomas F. Imperiale Colonoscopy and Colorectal Cancer Mortality Sudha Xirasagar and Piet C. de Groen Metrics 18 September 2018Volume 169, Issue 6Page: 424-425KeywordsAlgorithmsColonoscopyDisclosureGastroenterology and hepatologyMedical risk factorsMortalityObservational studiesOdds ratioRacial and ethnic issuesVeteran care ePublished: 18 September 2018 Issue Published: 18 September 2018 PDF downloadLoading ...