Proximal and Distal Colorectal Cancer Resection Rates in the United States Since Widespread Screening by Colonoscopy Parvathi A. Myer, Ajitha Mannalithara,

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Proximal and Distal Colorectal Cancer Resection Rates in the United States Since Widespread Screening by Colonoscopy Parvathi A. Myer, Ajitha Mannalithara, Gurkirpal Singh, Uri Ladabaum Gastroenterology Volume 143, Issue 5, Pages 1227-1236 (November 2012) DOI: 10.1053/j.gastro.2012.07.107 Copyright © 2012 AGA Institute Terms and Conditions

Figure 1 US colorectal cancer resection rates for all adults. In contrast with distal colorectal cancer resection rates, proximal colon cancer resection rates decreased significantly only after 2002. Curves show the results of Joinpoint analyses. (A) Colorectal cancer overall, (B) distal colorectal cancer, and (C) proximal colon cancer. Gastroenterology 2012 143, 1227-1236DOI: (10.1053/j.gastro.2012.07.107) Copyright © 2012 AGA Institute Terms and Conditions

Figure 2 US overall colorectal cancer resection rates by age group. In contrast with decreasing rates in adults eligible for screening, increasing rates were observed in younger adults. Curves show the results of Joinpoint analyses. (A) Persons aged ≥76 years, (B) persons aged 50–75 years, (C) persons aged 40–49 years, and (D) persons aged 18–39 years. Gastroenterology 2012 143, 1227-1236DOI: (10.1053/j.gastro.2012.07.107) Copyright © 2012 AGA Institute Terms and Conditions

Figure 3 US distal and proximal colorectal cancer resection rates by age group. Curves show the results of Joinpoint analyses. (A) Distal colorectal cancer in persons age ≥76 years. (B) Proximal colon cancer in persons age ≥76 years. (C) Distal colorectal cancer in persons age 50–75 years. (D) Proximal colon cancer in persons age 50–75 years. (E) Distal colorectal cancer in persons age 18–39 and 40–49 years. (F) Proximal colon cancer in persons age 18–39 and 40–49 years. Gastroenterology 2012 143, 1227-1236DOI: (10.1053/j.gastro.2012.07.107) Copyright © 2012 AGA Institute Terms and Conditions

Figure 4 US colorectal cancer resection rates by sex. Curves show the results of Joinpoint analyses. (A) Colorectal cancer overall in women, (B) colorectal cancer overall in men, (C) distal colorectal cancer in women, (D) distal colorectal cancer in men, (E) proximal colon cancer in women, and (F) proximal colon cancer in men. Gastroenterology 2012 143, 1227-1236DOI: (10.1053/j.gastro.2012.07.107) Copyright © 2012 AGA Institute Terms and Conditions

Figure 5 Trends in colorectal cancer resection rates and use of screening tests. (A) US colorectal cancer resection rates for all adults. Curves show the results of Joinpoint analyses. (B) Data on the prevalence of colorectal cancer screening in adults age 50 years and older from the Behavior Risk Factor Surveillance System.40 Colonoscopy has been the most common screening test since Medicare's decision to cover screening colonoscopy in average-risk persons in 2001, and similar decisions by commercial insurers. The American Cancer Society and subspecialty society guidelines endorsed screening colonoscopy in 1997, and the US Preventive Services Task Force endorsed it in 2002. Colonoscopy accounted for most lower endoscopies in the past decade, and sigmoidoscopy accounted for only a small fraction. Proximal colon cancer resection rates began decreasing only in the era of screening colonoscopy. Gastroenterology 2012 143, 1227-1236DOI: (10.1053/j.gastro.2012.07.107) Copyright © 2012 AGA Institute Terms and Conditions