Reanalysis of All-Cause Mortality in the U.S. Preventive Services Task Force 2016 Evidence Report on Colorectal Cancer Screening
Authors: Andrew W. Swartz, Jan M. Eberth, Michele J. Josey, Scott M. Strayer
Journal: Annals of Internal Medicine (2017)

Letters17 October 2017Reanalysis of All-Cause Mortality in the U.S. Preventive Services Task Force 2016 Evidence Report on Colorectal Cancer ScreeningAndrew W. Swartz, MD, Jan M. Eberth, PhD, Michele J. Josey, MS, and Scott M. Strayer, MDAndrew W. Swartz, MDFrom Yukon-Kuskokwim Delta Regional Hospital, Bethel, Alaska, and University of South Carolina, Columbia, South Carolina., Jan M. Eberth, PhDFrom Yukon-Kuskokwim Delta Regional Hospital, Bethel, Alaska, and University of South Carolina, Columbia, South Carolina., Michele J. Josey, MSFrom Yukon-Kuskokwim Delta Regional Hospital, Bethel, Alaska, and University of South Carolina, Columbia, South Carolina., and Scott M. Strayer, MDFrom Yukon-Kuskokwim Delta Regional Hospital, Bethel, Alaska, and University of South Carolina, Columbia, South Carolina.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0859 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: The 2016 U.S. Preventive Services Task Force (USPSTF) evidence report on colorectal cancer screening concluded that no colorectal cancer screening methods reduce all-cause mortality. This conclusion was partially based on a meta-analysis of 4 randomized trials that compared flexible sigmoidoscopy screening with no screening. The meta-analysis aggregated results from the 2 age cohorts of 1 of the trials—the NORCCAP (Norwegian Colorectal Cancer Prevention) study—as if these cohorts were a single trial (1). Aggregation of outcomes that have markedly different event rates, screening–control ratios, or both can create a Simpson paradox, a phenomenon where a finding exists in individual data ...References1. Lin JS, Piper MA, Perdue LA, Rutter CM, Webber EM, O'Connor E, et al. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;315:2576-94. [PMID: 27305422] doi:10.1001/jama.2016.3332 CrossrefMedlineGoogle Scholar2. Julious SA, Mullee MA. Confounding and Simpson's paradox. BMJ. 1994;309:1480-1. [PMID: 7804052] CrossrefMedlineGoogle Scholar3. Bretthauer M, Gondal G, Larsen K, Carlsen E, Eide TJ, Grotmol T, et al. Design, organization and management of a controlled population screening study for detection of colorectal neoplasia: attendance rates in the NORCCAP study (Norwegian Colorectal Cancer Prevention). Scand J Gastroenterol. 2002;37:568-73. [PMID: 12059059] CrossrefMedlineGoogle Scholar4. Holme Ø, Loberg M, Kalager M. Colorectal cancer and the effect of flexible sigmoidoscopy screening—reply [Letter]. JAMA. 2014;312:2411-2. [PMID: 25490338] doi:10.1001/jama.2014.14695 CrossrefMedlineGoogle Scholar5. R Development Core Team.. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2010. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Yukon-Kuskokwim Delta Regional Hospital, Bethel, Alaska, and University of South Carolina, Columbia, South Carolina.Disclaimer: No entity other than the authors had any input or role in the design, execution, composition, or decision to publish.Acknowledgment: The authors thank Olga Y. Gorlova, PhD (Geisel School of Medicine, Dartmouth University), and Gloria Ann Evans, FNP, DrPH (retired, Durham, North Carolina), for critical manuscript review and stylistic suggestions and Karen Matthias (Anchorage, Alaska) for stylistic suggestions.Financial Support: Dr. Eberth is supported in part by a Mentored Research Scholar Grant from the American Cancer Society (MRSG-15-148-01-CPHPS). Ms. Josey is supported in part by grant T32-GM081740 from the National Institutes of Health, National Institute of General Medical Sciences.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0859.This article was published at Annals.org on 22 August 2017. 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Eide, MD, PhD, Eva Skovlund, MSc, PhD, Jon Lekven, MD, PhD, Jörn Schneede, MD, PhD, Kjell Magne Tveit, MD, PhD, Morten Vatn, MD, PhD, Giske Ursin, MD, PhD, and Geir Hoff, MD, PhD, for the NORCCAP Study Group†† 17 October 2017Volume 167, Issue 8Page: 602-603KeywordsCancer preventionCancer screeningCohort studiesColorectal cancerColorectal cancer screeningFlexible sigmoidoscopyLung and intrathoracic tumorsMortalityOvarian cancerRelative risk ePublished: 22 August 2017 Issue Published: 17 October 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...