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Testing for Associations Between an Environmental Risk Score and Most Significant Colonoscopy Findings Among US Veterans in CSP #380
PURPOSE
To construct a composite score representing modifiable lifestyle and environmental risk (e-score) and test for associations with colonoscopy findings among US Veteran participants of CSP #380.
BACKGROUND
Understanding environmental and genetic risks beyond self-reported family history is a way to develop personalized colorectal cancer (CRC) screening. The Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO) study examined CRC risk stratified by sex and included an e-score along with genetic risk scores, where higher scores indicated higher risk. Both e-scores and genetic risk scores were significantly associated with CRC risk and models that included these were more robust than models that only included family history.
METHODS
CSP #380 is a prospective study of outcomes during colonoscopy screening (1994-97) and follow- up (1994-2009) for 3,121 asymptomatic Veterans aged 50-75. The dichotomous outcome of interest was most significant colonoscopy findings (MSCF) of i) advanced neoplasia (AN: ≥10mm adenomas or advanced histology, or invasive CRC) vs. ii) non-advanced adenomas (<10mm with tubular histology) or no neoplasia. The independent variable, e-score, was weighted according to the GECCO male sample and comprised BMI, height, diabetes, NSAID use, education, alcohol intake, smoking, exercise, and diet.
DATA ANALYSIS
Logistic regression was used to test associations between MSCF and e-scores, controlling for age, family history and number of colonoscopies.
RESULTS
Among 2,846 participants with complete data, 33.3% were aged 50-59 at baseline, 97% were male, and 83.8% were White. Those with AN (n=405, 14.2%) compared to those without AN (n=2,441, 85.8%) had higher median e-scores (29.5, range:0-99.8 vs. 29.0, range:5.2-100), suggesting a difference. The logistic regression models showed older participants (aOR: 1.04, 95% CI: 1.03-1.06) and those with more colonoscopies (aOR: 1.19, 95% CI: 1.06-1.33) had higher odds for AN. However, e-scores and family history were not significantly associated with MCSF.
IMPLICATIONS
E-scores were not significantly associated with MSCF in this preliminary study. Developing escores among a larger, diverse sample (N~381,695) of US veterans in the Million Veterans Program study will allow for stratified models in investigations of environmental and genetic risk for CRC. Outcomes from those analyses will support advances in screening guidelines with tailored programs for long-term CRC prevention.
PURPOSE
To construct a composite score representing modifiable lifestyle and environmental risk (e-score) and test for associations with colonoscopy findings among US Veteran participants of CSP #380.
BACKGROUND
Understanding environmental and genetic risks beyond self-reported family history is a way to develop personalized colorectal cancer (CRC) screening. The Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO) study examined CRC risk stratified by sex and included an e-score along with genetic risk scores, where higher scores indicated higher risk. Both e-scores and genetic risk scores were significantly associated with CRC risk and models that included these were more robust than models that only included family history.
METHODS
CSP #380 is a prospective study of outcomes during colonoscopy screening (1994-97) and follow- up (1994-2009) for 3,121 asymptomatic Veterans aged 50-75. The dichotomous outcome of interest was most significant colonoscopy findings (MSCF) of i) advanced neoplasia (AN: ≥10mm adenomas or advanced histology, or invasive CRC) vs. ii) non-advanced adenomas (<10mm with tubular histology) or no neoplasia. The independent variable, e-score, was weighted according to the GECCO male sample and comprised BMI, height, diabetes, NSAID use, education, alcohol intake, smoking, exercise, and diet.
DATA ANALYSIS
Logistic regression was used to test associations between MSCF and e-scores, controlling for age, family history and number of colonoscopies.
RESULTS
Among 2,846 participants with complete data, 33.3% were aged 50-59 at baseline, 97% were male, and 83.8% were White. Those with AN (n=405, 14.2%) compared to those without AN (n=2,441, 85.8%) had higher median e-scores (29.5, range:0-99.8 vs. 29.0, range:5.2-100), suggesting a difference. The logistic regression models showed older participants (aOR: 1.04, 95% CI: 1.03-1.06) and those with more colonoscopies (aOR: 1.19, 95% CI: 1.06-1.33) had higher odds for AN. However, e-scores and family history were not significantly associated with MCSF.
IMPLICATIONS
E-scores were not significantly associated with MSCF in this preliminary study. Developing escores among a larger, diverse sample (N~381,695) of US veterans in the Million Veterans Program study will allow for stratified models in investigations of environmental and genetic risk for CRC. Outcomes from those analyses will support advances in screening guidelines with tailored programs for long-term CRC prevention.
PURPOSE
To construct a composite score representing modifiable lifestyle and environmental risk (e-score) and test for associations with colonoscopy findings among US Veteran participants of CSP #380.
BACKGROUND
Understanding environmental and genetic risks beyond self-reported family history is a way to develop personalized colorectal cancer (CRC) screening. The Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO) study examined CRC risk stratified by sex and included an e-score along with genetic risk scores, where higher scores indicated higher risk. Both e-scores and genetic risk scores were significantly associated with CRC risk and models that included these were more robust than models that only included family history.
METHODS
CSP #380 is a prospective study of outcomes during colonoscopy screening (1994-97) and follow- up (1994-2009) for 3,121 asymptomatic Veterans aged 50-75. The dichotomous outcome of interest was most significant colonoscopy findings (MSCF) of i) advanced neoplasia (AN: ≥10mm adenomas or advanced histology, or invasive CRC) vs. ii) non-advanced adenomas (<10mm with tubular histology) or no neoplasia. The independent variable, e-score, was weighted according to the GECCO male sample and comprised BMI, height, diabetes, NSAID use, education, alcohol intake, smoking, exercise, and diet.
DATA ANALYSIS
Logistic regression was used to test associations between MSCF and e-scores, controlling for age, family history and number of colonoscopies.
RESULTS
Among 2,846 participants with complete data, 33.3% were aged 50-59 at baseline, 97% were male, and 83.8% were White. Those with AN (n=405, 14.2%) compared to those without AN (n=2,441, 85.8%) had higher median e-scores (29.5, range:0-99.8 vs. 29.0, range:5.2-100), suggesting a difference. The logistic regression models showed older participants (aOR: 1.04, 95% CI: 1.03-1.06) and those with more colonoscopies (aOR: 1.19, 95% CI: 1.06-1.33) had higher odds for AN. However, e-scores and family history were not significantly associated with MCSF.
IMPLICATIONS
E-scores were not significantly associated with MSCF in this preliminary study. Developing escores among a larger, diverse sample (N~381,695) of US veterans in the Million Veterans Program study will allow for stratified models in investigations of environmental and genetic risk for CRC. Outcomes from those analyses will support advances in screening guidelines with tailored programs for long-term CRC prevention.
Associations Between Colorectal Cancer Progression and Dietary Patterns of US Veterans in CSP #380
PURPOSE
To analyze associations between colorectal cancer progression and diet scores calculated using published scoring approaches for three dietary patterns: Healthy Eating Index (HEI), Mediterranean Diet (Mediterranean), and Dietary Approaches to Stop Hypertension Diet (DASH).
BACKGROUND
Little is known about whether longterm risk for progression to colorectal cancer is associated with recommended healthy dietary patterns among US veterans. Previous studies of veterans have shown higher intake of fiber and vitamin D reduced risk, and red meat increased risk for finding colorectal cancer precursors during colonoscopy. However, studying dietary patterns in aggregate may be more clinically relevant for longitudinal studies of colorectal cancer prevention.
METHODS
3,121 asymptomatic US veterans aged 50-75 received colonoscopy between 1994-97 and were followed through 2009. Most significant colonoscopy findings (MSCF) across the study period were: (i) no neoplasia (NN), (ii) non-advanced adenomas (NAAs) or (iii) advanced neoplasia (AN). Baseline dietary questionnaire data were used to calculate three dietary pattern (HEI, Mediterranean, and DASH) scores.
DATA ANALYSIS
Multinomial logistic regression models were used in a cross-sectional analysis to test for associations represented by adjusted odds ratios (aOR) between MSCF and dietary pattern scores, controlling for demographics and clinical risk factors.
RESULTS
Among 3,023 participants with complete data, 97% were male, and 83.8% were White. Increasing scores, representing healthier diets, for each dietary pattern had similar or lower odds for NAAs and AN, respectively, versus NN. They were HEI: aOR: 1.00, 95% CI: 0.99-1.01 and aOR 0.97, 95% CI: 0.99-1.01; Mediterranean: aOR: 0.98, 95% CI: 0.95-1.02 and aOR 0.95, 95% CI: 0.90-0.999; DASH: aOR: 0.99, 95% CI: 0.99- 1.00 and aOR 0.99, 95% CI: 0.98-0.999. Across each dietary pattern, higher whole grain and fiber category scores generally had lower odds for NAAs and AN.
CONCLUSIONS
Study results revealed that overall higher dietary quality and specific dietary components of whole grain or fiber intake, based on three different dietary patterns suggest lower odds for CRC precursors. Findings indicate potential differences in dietary intake patterns and more research is needed to determine the benefit of developing tailored CRC screening and surveillance clinical guidelines.
PURPOSE
To analyze associations between colorectal cancer progression and diet scores calculated using published scoring approaches for three dietary patterns: Healthy Eating Index (HEI), Mediterranean Diet (Mediterranean), and Dietary Approaches to Stop Hypertension Diet (DASH).
BACKGROUND
Little is known about whether longterm risk for progression to colorectal cancer is associated with recommended healthy dietary patterns among US veterans. Previous studies of veterans have shown higher intake of fiber and vitamin D reduced risk, and red meat increased risk for finding colorectal cancer precursors during colonoscopy. However, studying dietary patterns in aggregate may be more clinically relevant for longitudinal studies of colorectal cancer prevention.
METHODS
3,121 asymptomatic US veterans aged 50-75 received colonoscopy between 1994-97 and were followed through 2009. Most significant colonoscopy findings (MSCF) across the study period were: (i) no neoplasia (NN), (ii) non-advanced adenomas (NAAs) or (iii) advanced neoplasia (AN). Baseline dietary questionnaire data were used to calculate three dietary pattern (HEI, Mediterranean, and DASH) scores.
DATA ANALYSIS
Multinomial logistic regression models were used in a cross-sectional analysis to test for associations represented by adjusted odds ratios (aOR) between MSCF and dietary pattern scores, controlling for demographics and clinical risk factors.
RESULTS
Among 3,023 participants with complete data, 97% were male, and 83.8% were White. Increasing scores, representing healthier diets, for each dietary pattern had similar or lower odds for NAAs and AN, respectively, versus NN. They were HEI: aOR: 1.00, 95% CI: 0.99-1.01 and aOR 0.97, 95% CI: 0.99-1.01; Mediterranean: aOR: 0.98, 95% CI: 0.95-1.02 and aOR 0.95, 95% CI: 0.90-0.999; DASH: aOR: 0.99, 95% CI: 0.99- 1.00 and aOR 0.99, 95% CI: 0.98-0.999. Across each dietary pattern, higher whole grain and fiber category scores generally had lower odds for NAAs and AN.
CONCLUSIONS
Study results revealed that overall higher dietary quality and specific dietary components of whole grain or fiber intake, based on three different dietary patterns suggest lower odds for CRC precursors. Findings indicate potential differences in dietary intake patterns and more research is needed to determine the benefit of developing tailored CRC screening and surveillance clinical guidelines.
PURPOSE
To analyze associations between colorectal cancer progression and diet scores calculated using published scoring approaches for three dietary patterns: Healthy Eating Index (HEI), Mediterranean Diet (Mediterranean), and Dietary Approaches to Stop Hypertension Diet (DASH).
BACKGROUND
Little is known about whether longterm risk for progression to colorectal cancer is associated with recommended healthy dietary patterns among US veterans. Previous studies of veterans have shown higher intake of fiber and vitamin D reduced risk, and red meat increased risk for finding colorectal cancer precursors during colonoscopy. However, studying dietary patterns in aggregate may be more clinically relevant for longitudinal studies of colorectal cancer prevention.
METHODS
3,121 asymptomatic US veterans aged 50-75 received colonoscopy between 1994-97 and were followed through 2009. Most significant colonoscopy findings (MSCF) across the study period were: (i) no neoplasia (NN), (ii) non-advanced adenomas (NAAs) or (iii) advanced neoplasia (AN). Baseline dietary questionnaire data were used to calculate three dietary pattern (HEI, Mediterranean, and DASH) scores.
DATA ANALYSIS
Multinomial logistic regression models were used in a cross-sectional analysis to test for associations represented by adjusted odds ratios (aOR) between MSCF and dietary pattern scores, controlling for demographics and clinical risk factors.
RESULTS
Among 3,023 participants with complete data, 97% were male, and 83.8% were White. Increasing scores, representing healthier diets, for each dietary pattern had similar or lower odds for NAAs and AN, respectively, versus NN. They were HEI: aOR: 1.00, 95% CI: 0.99-1.01 and aOR 0.97, 95% CI: 0.99-1.01; Mediterranean: aOR: 0.98, 95% CI: 0.95-1.02 and aOR 0.95, 95% CI: 0.90-0.999; DASH: aOR: 0.99, 95% CI: 0.99- 1.00 and aOR 0.99, 95% CI: 0.98-0.999. Across each dietary pattern, higher whole grain and fiber category scores generally had lower odds for NAAs and AN.
CONCLUSIONS
Study results revealed that overall higher dietary quality and specific dietary components of whole grain or fiber intake, based on three different dietary patterns suggest lower odds for CRC precursors. Findings indicate potential differences in dietary intake patterns and more research is needed to determine the benefit of developing tailored CRC screening and surveillance clinical guidelines.
The Association of Modifiable Baseline Risk Factors with a Diagnosis of Advanced Neoplasia Among an Asymptomatic Veteran Population
BACKGROUND: Colorectal cancer (CRC) screening guidelines generally recommend healthy lifestyle choices for cancer prevention. However, studies have shown inconsistent associations between various risk factors and advanced neoplasia (AN) development. AIM: To identify potentially modifiable baseline dietary and lifestyle risk factors associated with AN among an asymptomatic Veteran population, while accounting for prior colonoscopic findings and varying surveillance intensity.
METHODS: We used data from a prospective colonoscopy screening study collected by the VA Cooperative Studies Program. From 1994 to 1997, 3,121 asymptomatic Veterans aged 50-75 received a baseline colonoscopy screening, at which time they selfreported dietary and lifestyle information. Veterans were subsequently assigned to colonoscopy surveillance regimens and followed for 10 years. AN was defined as invasive CRC or any adenoma ≥1 cm, or with villous histology, or high-grade dysplasia. To detect associations with AN diagnosis, we utilized a longitudinal joint model with two sub-models. A multivariate logistic regression modeled the longitudinal probability of AN, while a time-to-event process adjusted for survival. Here we focus on the multivariate logistic regression, representing associations of dietary and lifestyle risk factors with the odds of being diagnosed with AN.
RESULTS: Of the 3,121 Veterans, 1,915 received at least one colonoscopy following baseline screening. Among the 1,915, we detected a significant positive association with AN for current daily smokers (odds ratio (OR) 1.43, 95% CI: 1.02-2.01) compared to those with prior or no history. We found a protective effect for each 100 IU of dietary vitamin D consumed (OR 0.95, 95% CI: 0.95-0.99). We did not detect any significant associations with BMI, red meat consumption, or physical activity. We found that African American race had a lower odds of AN compared to Caucasian race (OR 0.57, 95% CI: 0.32-0.97).
CONCLUSIONS: We identified smoking status and vitamin D consumption as potentially modifiable baseline risk factors associated with AN development. While these results suggest possible points of intervention and targeted screening, more evidence is required across more diverse populations. Future efforts should focus on understanding changes in such risk factors on associations with AN for patients over time. Finally, racial differences in AN incidence merit further investigation.
BACKGROUND: Colorectal cancer (CRC) screening guidelines generally recommend healthy lifestyle choices for cancer prevention. However, studies have shown inconsistent associations between various risk factors and advanced neoplasia (AN) development. AIM: To identify potentially modifiable baseline dietary and lifestyle risk factors associated with AN among an asymptomatic Veteran population, while accounting for prior colonoscopic findings and varying surveillance intensity.
METHODS: We used data from a prospective colonoscopy screening study collected by the VA Cooperative Studies Program. From 1994 to 1997, 3,121 asymptomatic Veterans aged 50-75 received a baseline colonoscopy screening, at which time they selfreported dietary and lifestyle information. Veterans were subsequently assigned to colonoscopy surveillance regimens and followed for 10 years. AN was defined as invasive CRC or any adenoma ≥1 cm, or with villous histology, or high-grade dysplasia. To detect associations with AN diagnosis, we utilized a longitudinal joint model with two sub-models. A multivariate logistic regression modeled the longitudinal probability of AN, while a time-to-event process adjusted for survival. Here we focus on the multivariate logistic regression, representing associations of dietary and lifestyle risk factors with the odds of being diagnosed with AN.
RESULTS: Of the 3,121 Veterans, 1,915 received at least one colonoscopy following baseline screening. Among the 1,915, we detected a significant positive association with AN for current daily smokers (odds ratio (OR) 1.43, 95% CI: 1.02-2.01) compared to those with prior or no history. We found a protective effect for each 100 IU of dietary vitamin D consumed (OR 0.95, 95% CI: 0.95-0.99). We did not detect any significant associations with BMI, red meat consumption, or physical activity. We found that African American race had a lower odds of AN compared to Caucasian race (OR 0.57, 95% CI: 0.32-0.97).
CONCLUSIONS: We identified smoking status and vitamin D consumption as potentially modifiable baseline risk factors associated with AN development. While these results suggest possible points of intervention and targeted screening, more evidence is required across more diverse populations. Future efforts should focus on understanding changes in such risk factors on associations with AN for patients over time. Finally, racial differences in AN incidence merit further investigation.
BACKGROUND: Colorectal cancer (CRC) screening guidelines generally recommend healthy lifestyle choices for cancer prevention. However, studies have shown inconsistent associations between various risk factors and advanced neoplasia (AN) development. AIM: To identify potentially modifiable baseline dietary and lifestyle risk factors associated with AN among an asymptomatic Veteran population, while accounting for prior colonoscopic findings and varying surveillance intensity.
METHODS: We used data from a prospective colonoscopy screening study collected by the VA Cooperative Studies Program. From 1994 to 1997, 3,121 asymptomatic Veterans aged 50-75 received a baseline colonoscopy screening, at which time they selfreported dietary and lifestyle information. Veterans were subsequently assigned to colonoscopy surveillance regimens and followed for 10 years. AN was defined as invasive CRC or any adenoma ≥1 cm, or with villous histology, or high-grade dysplasia. To detect associations with AN diagnosis, we utilized a longitudinal joint model with two sub-models. A multivariate logistic regression modeled the longitudinal probability of AN, while a time-to-event process adjusted for survival. Here we focus on the multivariate logistic regression, representing associations of dietary and lifestyle risk factors with the odds of being diagnosed with AN.
RESULTS: Of the 3,121 Veterans, 1,915 received at least one colonoscopy following baseline screening. Among the 1,915, we detected a significant positive association with AN for current daily smokers (odds ratio (OR) 1.43, 95% CI: 1.02-2.01) compared to those with prior or no history. We found a protective effect for each 100 IU of dietary vitamin D consumed (OR 0.95, 95% CI: 0.95-0.99). We did not detect any significant associations with BMI, red meat consumption, or physical activity. We found that African American race had a lower odds of AN compared to Caucasian race (OR 0.57, 95% CI: 0.32-0.97).
CONCLUSIONS: We identified smoking status and vitamin D consumption as potentially modifiable baseline risk factors associated with AN development. While these results suggest possible points of intervention and targeted screening, more evidence is required across more diverse populations. Future efforts should focus on understanding changes in such risk factors on associations with AN for patients over time. Finally, racial differences in AN incidence merit further investigation.
Screening Colonoscopy Findings Are Associated With Non-Colorectal Cancer Mortality
PURPOSE: Examine whether baseline colonoscopy findings are associated with non-Colorectal Cancer (CRC) mortality in a Veteran screening population.
BACKGROUND: Although screening colonoscopy findings are associated with future risk of CRC mortality, whether these findings are also associated with non- CRC mortality remains unknown.
METHODS: The Cooperative Studies Program (CSP) #380 cohort is comprised of 3,121 Veterans age 50-75 who underwent screening colonoscopy from 1994-97. Veterans were followed for 10 years or death, as verified in electronic medical records. Those who died from CRC-specific causes were excluded from this analysis (n=18, 0.6%). Hazard ratios (HR) for risk factors on non-CRC mortality were calculated by Cox Proportional Hazard model, adjusting for demographics, baseline comorbidities, and lifestyle factors. Information on comorbidities, family history, diet, physical activity, and medications were obtained from self-reported questionnaires at baseline.
RESULTS: Of the included 3,103 Veterans, most were male (n=3,021, 96.8%), white (n=2,609, 83.6%), with a mean age of 62.9. During the 10-year follow-up period, 837 (27.0%) Veterans died from non-CRC causes. The risk of non-CRC mortality was higher in Veterans with ≥3 small adenomas (HR 1.45, p=0.02), advanced adenomas (HR 1.34, p=0.04), or CRC (HR 3.00, =0.05) on baseline colonoscopy when compared to Veterans without neoplasia. Additionally, increasing age (HR 1.07, <0.001), modified Charlson score (HR 1.57 for 3-4 points, <0.001, compared to 0-2 points) and current smoking (HR 2.09, <0.001, compared to former and non-smokers) were associated with higher non-CRC mortality. On the other hand, increasing physical activity (HR 0.88, <0.001), family history of CRC (HR 0.75, =0.02), and increased BMI (HR 0.73-0.75, <0.01) were associated with reduced non-CRC mortality. Neither race, NSAID use (including aspirin), or dietary factors impacted non-CRC mortality.
CONCLUSIONS: In a Veteran CRC screening population, we found that high-risk adenomas or CRC on baseline colonoscopy were independently associated with increased non-CRC mortality within 10 years. Future work will examine the cause-specific factors associated with non-CRC mortality in these groups to 1) identify potential high-yield strategies for tailored non-CRC mortality risk reduction during CRC screening, and 2) better determine when competing risks of non-CRC mortality outweigh the benefit of follow up colonoscopy.
PURPOSE: Examine whether baseline colonoscopy findings are associated with non-Colorectal Cancer (CRC) mortality in a Veteran screening population.
BACKGROUND: Although screening colonoscopy findings are associated with future risk of CRC mortality, whether these findings are also associated with non- CRC mortality remains unknown.
METHODS: The Cooperative Studies Program (CSP) #380 cohort is comprised of 3,121 Veterans age 50-75 who underwent screening colonoscopy from 1994-97. Veterans were followed for 10 years or death, as verified in electronic medical records. Those who died from CRC-specific causes were excluded from this analysis (n=18, 0.6%). Hazard ratios (HR) for risk factors on non-CRC mortality were calculated by Cox Proportional Hazard model, adjusting for demographics, baseline comorbidities, and lifestyle factors. Information on comorbidities, family history, diet, physical activity, and medications were obtained from self-reported questionnaires at baseline.
RESULTS: Of the included 3,103 Veterans, most were male (n=3,021, 96.8%), white (n=2,609, 83.6%), with a mean age of 62.9. During the 10-year follow-up period, 837 (27.0%) Veterans died from non-CRC causes. The risk of non-CRC mortality was higher in Veterans with ≥3 small adenomas (HR 1.45, p=0.02), advanced adenomas (HR 1.34, p=0.04), or CRC (HR 3.00, =0.05) on baseline colonoscopy when compared to Veterans without neoplasia. Additionally, increasing age (HR 1.07, <0.001), modified Charlson score (HR 1.57 for 3-4 points, <0.001, compared to 0-2 points) and current smoking (HR 2.09, <0.001, compared to former and non-smokers) were associated with higher non-CRC mortality. On the other hand, increasing physical activity (HR 0.88, <0.001), family history of CRC (HR 0.75, =0.02), and increased BMI (HR 0.73-0.75, <0.01) were associated with reduced non-CRC mortality. Neither race, NSAID use (including aspirin), or dietary factors impacted non-CRC mortality.
CONCLUSIONS: In a Veteran CRC screening population, we found that high-risk adenomas or CRC on baseline colonoscopy were independently associated with increased non-CRC mortality within 10 years. Future work will examine the cause-specific factors associated with non-CRC mortality in these groups to 1) identify potential high-yield strategies for tailored non-CRC mortality risk reduction during CRC screening, and 2) better determine when competing risks of non-CRC mortality outweigh the benefit of follow up colonoscopy.
PURPOSE: Examine whether baseline colonoscopy findings are associated with non-Colorectal Cancer (CRC) mortality in a Veteran screening population.
BACKGROUND: Although screening colonoscopy findings are associated with future risk of CRC mortality, whether these findings are also associated with non- CRC mortality remains unknown.
METHODS: The Cooperative Studies Program (CSP) #380 cohort is comprised of 3,121 Veterans age 50-75 who underwent screening colonoscopy from 1994-97. Veterans were followed for 10 years or death, as verified in electronic medical records. Those who died from CRC-specific causes were excluded from this analysis (n=18, 0.6%). Hazard ratios (HR) for risk factors on non-CRC mortality were calculated by Cox Proportional Hazard model, adjusting for demographics, baseline comorbidities, and lifestyle factors. Information on comorbidities, family history, diet, physical activity, and medications were obtained from self-reported questionnaires at baseline.
RESULTS: Of the included 3,103 Veterans, most were male (n=3,021, 96.8%), white (n=2,609, 83.6%), with a mean age of 62.9. During the 10-year follow-up period, 837 (27.0%) Veterans died from non-CRC causes. The risk of non-CRC mortality was higher in Veterans with ≥3 small adenomas (HR 1.45, p=0.02), advanced adenomas (HR 1.34, p=0.04), or CRC (HR 3.00, =0.05) on baseline colonoscopy when compared to Veterans without neoplasia. Additionally, increasing age (HR 1.07, <0.001), modified Charlson score (HR 1.57 for 3-4 points, <0.001, compared to 0-2 points) and current smoking (HR 2.09, <0.001, compared to former and non-smokers) were associated with higher non-CRC mortality. On the other hand, increasing physical activity (HR 0.88, <0.001), family history of CRC (HR 0.75, =0.02), and increased BMI (HR 0.73-0.75, <0.01) were associated with reduced non-CRC mortality. Neither race, NSAID use (including aspirin), or dietary factors impacted non-CRC mortality.
CONCLUSIONS: In a Veteran CRC screening population, we found that high-risk adenomas or CRC on baseline colonoscopy were independently associated with increased non-CRC mortality within 10 years. Future work will examine the cause-specific factors associated with non-CRC mortality in these groups to 1) identify potential high-yield strategies for tailored non-CRC mortality risk reduction during CRC screening, and 2) better determine when competing risks of non-CRC mortality outweigh the benefit of follow up colonoscopy.