American Journal of Epidemiology Advance Access originally published online on April 23, 2007
American Journal of Epidemiology 2007 166(2):130-136; doi:10.1093/aje/kwm062
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PRACTICE OF EPIDEMIOLOGY |
Validity of Self-Reported Endoscopies of the Large Bowel and Implications for Estimates of Colorectal Cancer Risk
1 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
2 Division of Cancer Epidemiology, Unit of Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
Correspondence to Dr. Hermann Brenner, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Bergheimer Strasse 20, D-69115 Heidelberg, Germany (e-mail: h.brenner{at}dkfz-heidelberg.de).
Received for publication October 17, 2006. Accepted for publication January 22, 2007.
Large-bowel endoscopy with removal of polyps strongly reduces colorectal cancer risk. In epidemiologic studies, ascertainment of large-bowel endoscopies often relies on self-reports and might be prone to imperfect recall. In 2003–2004, the authors assessed the validity of self-reported colorectal endoscopies in a population-based case-control study including 540 cases and 614 controls from southwest Germany and calculated odds ratios of colorectal cancer risk according to self-reports and medical records. They sought to obtain all medical records for the last self-reported endoscopy and for a subsample of 100 subjects reporting no previous endoscopy. In total, 377 of 483 records could be obtained (78%). Sensitivity of self-reports was 100%, and specificity ranged from 93% to 98% among subgroups defined by age, gender, education, family history of colorectal cancer, and case-control status. The odds ratios for colorectal cancer risk after previous colonoscopy were 0.31 (95% confidence interval: 0.21, 0.45) using self-reports and 0.31 (95% confidence interval: 0.20, 0.47) using medical records. However, agreement between self-reports and medical records was poor regarding type of endoscopy (colonoscopy, sigmoidoscopy, or rectoscopy; kappa = 0.22), moderate concerning polypectomy (kappa = 0.58), and reasonable for year of examination (kappa = 0.70). Self-reports of previous colorectal endoscopies agreed well with medical records, but validation appears to be essential with respect to details of the examination.
colonoscopy; colorectal neoplasms; endoscopy; mass screening; reproducibility of results; risk; validation studies
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