Ronald L. Koretz, MD
Does an offer of once-only flexible sigmoidoscopy screening in persons 55 to 64 years of age reduce colorectal cancer incidence and mortality?
Randomized controlled trial (UK Flexible Sigmoidoscopy Trial). Current Controlled Trials ISRCTN28352761.
Unclear allocation concealment.*
Median follow-up was 11.2 years.
14 centers in the UK (506 general practices).
170 432 persons 55 to 64 years of age (mean age 60 y, 51% women) who were registered with participating primary care practices and indicated that they would accept an offer of colorectal cancer screening. Exclusion criteria were history of colorectal cancer, adenomas, or inflammatory bowel disease; severe or terminal illness; life expectancy < 5 years; or sigmoidoscopy or colonoscopy in the past 3 years.
Offer of an appointment for flexible sigmoidoscopy screening (n = 57 237) or no offer (control) (n = 113 195). Screening involved flexible sigmoidoscopy with polypectomy for small polyps and referral for colonoscopy for polyps ≥ 1 cm, ≥ 3 adenomas, tubulovillous or villous histology, severe dysplasia or malignant disease, or ≥ 20 hyperplastic polyps above the distal rectum.
Main outcomes were colorectal cancer incidence and mortality; secondary outcomes included distal and proximal cancer and all-cause mortality.
99.4% (intention-to-treat analysis).
2524 participants were diagnosed with colorectal cancer, and 727 died of the disease. Incidence and mortality were lower in the screening-offer group than in the no-offer group; incidence of distal cancer was also lower (Table). Groups did not differ for incidence of proximal cancer or all-cause mortality (Table).
An offer of once-only flexible sigmoidoscopy screening in persons 55 to 64 years of age reduced colorectal cancer incidence and mortality.
Offer of flexible sigmoidoscopy screening for colorectal cancer vs no offer of screening†
†NNS = number needed to screen; other abbreviations defined in Glossary. RRR, NNS, and CI calculated from hazard ratios and control event rates in article.
Koretz RL. Once-only flexible sigmoidoscopy screening reduced colorectal cancer incidence and mortality. Ann Intern Med. 2010;153:JC4–4. doi: 10.7326/0003-4819-153-8-201010190-02004
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Published: Ann Intern Med. 2010;153(8):JC4-4.
Colonoscopy/Sigmoidoscopy, Colorectal Cancer, Gastroenterology/Hepatology, Gastrointestinal Cancer, Hematology/Oncology.
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