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January 11, 2012

Sex-Specific Prevalence of Adenomas and Colorectal Cancer—Reply

Author Affiliations

Author Affiliations: Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria (monika.ferlitsch@meduniwien.ac.at).

JAMA. 2012;307(2):142-144. doi:10.1001/jama.2011.1981

In Reply: Drs Roy and Bianchi suggest patient referral to screening colonoscopy should take into account additional risk factors for advanced adenoma and colorectal cancer beyond sex, which was identified in our study. Identification of additional risk factors would make screening colonoscopy more efficient in detecting and removing advanced adenoma and colorectal cancer.

Roy and Bianchi indicate that the modest numbers and unusually high colorectal cancer prevalence in our study might raise concerns about the generalizability of our findings. In Austria, colonoscopy has been used for population screening since 2005. The prevalence of colorectal cancer of 1.1% in our study is comparable with the 0.9% prevalence described by Regula et al1 in Poland. In addition, we found prevalences of colorectal cancer in men that were twice as high as in women (1.5% vs 0.7%, respectively; odds ratio, 2.1). According to the Globocan 2008 database,2 the age-standardized mortality from colorectal cancer was higher in men than women in Austria (15 per 100 000 for men and 8 per 100 000 for women), and both were higher than in the United States (9.9 per 100 000 for men and 7.7 per 100 000 for women). The incidence of colorectal cancer was slightly lower in Austria compared with the United States (33.9 per 100 000 for men and 19.9 per 100 000 for women in Austria; 34.1 per 100 000 for men and 25 per 100 000 for women in the United States2). We therefore conclude that our findings are most likely generalizable to current colorectal cancer incidence and mortality.