Endoscopy 2025; 57(05): 451-459
DOI: 10.1055/a-2463-1737
Original article

Association between colonoscopy and colorectal cancer occurrence and mortality in the older population: a population-based cohort study

Ji Young Lee
1   Health Screening and Promotion Center, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea (the Republic of)
,
Jae Myung Cha
2   Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
,
Jin Young Yoon
2   Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
,
Min Seob Kwak
2   Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, College of Medicine, Kyung Hee University, Seoul, Korea (the Republic of)
,
Hun Hee Lee
3   Big Data Center, Kyung Hee University Hospital at Gang Dong, Seoul, Korea (the Republic of)
› Author Affiliations

Supported by: Research Supporting Program of the Korean Association for the Study of Intestinal Diseases for 2021
Preview

Abstract

Background

We aimed to evaluate the association between colonoscopy and colorectal cancer (CRC) occurrence and related mortality in an older population.

Methods

This retrospective, nationwide, population-based cohort study used data of adults aged ≥40 years from the Health Insurance Review and Assessment Service database. After excluding colonoscopy within 6 months of CRC diagnosis during enrollment, CRC occurrence and related mortality were compared between colonoscopy and non-colonoscopy groups using a time-dependent Cox proportional hazard model. Subgroup analysis was conducted among four age groups: young, middle-aged, old, and very old.

Results

Among 748986 individuals followed for 9.64 (SD 0.99) years, the colonoscopy group had a 65% lower CRC occurrence (adjusted hazard ratio [HRa] 0.35, 95%CI 0.32–0.38) and 76% lower CRC-related mortality (HRa 0.24, 95%CI 0.18–0.31) after 5 years compared with the non-colonoscopy group. Colonoscopy was associated with the most significant reduction in CRC occurrence in the middle-aged group (HRa 0.32, 95%CI 0.29–0.35) and in CRC-related mortality in the young group (HRa 0.04, 95%CI 0.01–0.33); the very old group had the least reduction in both CRC occurrence and CRC-related mortality (HRa 0.44, 95%CI 0.33–0.59 and HRa 0.28, 95%CI 0.15–0.53, respectively).

Conclusion

We found a significant association between colonoscopy and reduction in CRC occurrence and CRC-related mortality in adults aged ≥40 years after 5 years of follow-up; however, these associations were weaker in the very old group. More research is needed on the association between colonoscopy and older age.

Supplementary Material



Publication History

Received: 19 March 2024

Accepted after revision: 06 November 2024

Accepted Manuscript online:
06 November 2024

Article published online:
10 January 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany