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To quantify the association of self-reported lower gastrointestinal endoscopy use measured in 2004/05 with colorectal cancer (CRC) mortality changes over 2004-2015 in Europe. An ecological analysis was performed using endoscopy utilization data from the Survey of Health, Aging, and Retirement in 11 European countries in 2004/05 and CRC mortality data from the World Health Organization Mortality Database over 2004-2015. Mortality trends were compared through annual mortality changes from joinpoint regression models. Cross-national varia