gms | German Medical Science

Background: In October 2002, screening colonoscopy has been introduced in the German early cancer detection program. Introduction has been escorted by a concomitant cross-sectional evaluation of the acceptance, safety and tumour detection rate, but additional longitudinal follow-up of screenees will be essential for evaluation of the impact of screening colonoscopy on colorectal cancer incidence and mortality.

Methods: A statewide prospective cohort study was set up in Saarland to compare CRC incidence and mortality among participants in screening colonoscopy with CRC incidence and mortality in the general population of the same age. All women and men from Saarland undergoing screening colonoscopy between July 2005 and June 2008 are invited to participate. The study is purely observational and includes a questionnaire to assess potential risk factors for colorectal adenoma and carcinoma, the macroscopic and histopathological result of the screening colonoscopy and a passive follow-up to examine incidence of colorectal carcinoma and mortality over the next 15 years by annual linkage with the Saarland cancer registry and residents’ registration office. The study is actively supported by virtually all gastroenterologists from Saarland, who offer screening colonoscopy. Potential study participants are identified and informed by their treating physician. Assuming a 50% participation rate, a sample size of 10 500 study participants is aspired. The study protocol has been approved by local and regional ethics committee and the data protection officer of Saarland.

Perspectives: The recruitment of the study participants has started successfully and first results are expected shortly after closure of the baseline recruitment. In addition to the longitudinal monitoring of the effects on CRC incidence and mortality in participants of the screening program, the study also offers the possibility to identify potential risk factors for colorectal adenoma, which may help to develop more cost-effective approaches by focusing on high-risk groups.