Did Getting a Colonoscopy Lead to Cleaner Living?

Individuals who underwent endoscopic screenings said they started to live a healthier lifestyle afterwards, especially for those with severe findings, researchers found.

A finding of colon cancer on a screening had a stronger association with reported adherence to a healthy lifestyle (OR 1.55, 95% CI 1.17-2.05) than high-risk polyps (OR 1.42, 95% CI 1.14-1.77) or low-risk polyps (OR 1.19, 95% CI 1.07-1.33), but the improvements in lifestyle scores were still modest, reported Mingyang Song, ScD, from Harvard T.H. Chan School of Public Health in Boston, and colleagues, writing in Clinical Gastroenterology and Hepatology.

“We were surprised by the observation that diet barely changed after endoscopic screening, even among patients detected with high-risk polyps or colorectal cancer,” Song told MedPage Today. “This is surprising because patients are often recommended to improve their diet, particularly increasing fiber intake, after a positive screening.”

Incidence and mortality of colorectal cancer has been shown to decrease with more endoscopy screenings. Modifiable risk factors to promote a healthier lifestyle can reduce the risk of early death from colorectal cancer. Previous studies attempted to evaluate the effects of colorectal cancer on lifestyle factors, but have largely been inconclusive due to numerous limitations of sample sizes, follow-up durations and more, the authors said. Prior research showed receiving a screening colonoscopy was associated with a 67% decreased risk of death from colorectal cancer.

The authors aimed to study lifestyle changes following an endoscopic screening to prevent colorectal cancer. Data came from the Nurses’ Health Study I and II, in addition to the Health Professionals Follow-up study. Overall, 73,303 pairs of participants who reported having had a first time endoscopic screening were matched by age and sex with those who did not report a first time screening.

With data collected every 2 to 4 years, adult participants were enrolled from 1976, and 1986 to 1991. The survey assessed 12 lifestyle factors, including regular use of aspirin or NSAIDs, smoking, physical activity, body weight, and eight diet factors. Participants were followed up for an average of 17 years.

Adherence to a healthy lifestyle was calculated on a scale of 0 to 5 based on five factors: smoking, alcohol, body weight, physical activity, and diet. Analyses were adjusted for covariates such as ethnicity, sex, follow-up time, positive colorectal cancer family history, chronic diseases, and having a physical exam within the last two years.

There were 69,251 participants with a negative endoscopic screening and 7,052 participants with a positive screening or neoplastic findings. Median age was 55 and 82% were women. Among those who screened positive, 251 participants had colorectal cancer, 1,457 had high-risk polyps, and 5,344 had low-risk polyps.

Overall, the authors found an increase in adhering to the highest lifestyle score of 5 following screening (OR 1.09, 95% CI 1.04-1.06).

Song and colleagues observed a decreased prevalence of regular aspirin or NSAID use following screening. More importantly, researchers did not find any clinically significant changes in alcohol or dietary factors.

“Our finding highlights the need for enhanced effort to facilitate dietary modification in patients undergoing colorectal cancer screening,” Song added.

The authors agreed that “Given the importance of lifestyle for colorectal cancer prevention, integrating patient education in lifestyle modification could improve the benefit of colorectal cancer screening,” they stated.

Authors acknowledged several limitations of this study, which included the use of self-reported questionnaires to determine a healthy lifestyle. Furthermore, the participants were solely healthcare professionals, where their lifestyle factors could drastically differ due to their greater health consciousness from the general population, making findings non-generalizable to the public at large. Other screening methods (such as the fecal occult blood test) were not assessed.

Song told MedPage Today that he envisioned several areas for future research: “one, to evaluate the effect of lifestyle modification among high-risk individuals after screening, two, to identify the barriers for lifestyle modification among screening attendees who have high-risk findings, and three, to develop approaches for better integrating lifestyle modification into the screening setting to improve cancer prevention, through behavioral and community research,” he said.