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Summaries for Patients |5 June 2018

Sigmoidoscopy Screening for Colorectal Cancer Free

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 24 April 2018.

  • The full report is titled “Long-Term Effectiveness of Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality in Women and Men. A Randomized Trial.” The authors are Ø. Holme, M. Løberg, M. Kalager, M. Bretthauer, M.A. Hernán, E. Aas, T.J. Eide, E. Skovlund, J. Lekven, J. Schneede, K.M. Tveit, M. Vatn, G. Ursin, and G. Hoff, for the NORCCAP Study Group.


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What is the problem and what is known about it so far?

Two of the most popular procedures to screen for cancer of the colon and rectum are colonoscopy and sigmoidoscopy. Colonoscopy uses a 4-foot-long, flexible tube about the thickness of a finger that is inserted into the person's anus and then advanced. The doctor looks through the other end, takes pictures, and sometimes takes small samples of tissue. This procedure can examine all of the places where colorectal cancer occurs, but it often requires sedation, which means that the person needs help getting home afterward. Sigmoidoscopy is similar except that the scope is advanced a shorter distance into the bowel; it also examines only some of the places where colorectal cancer occurs, and sedation usually is not necessary. Both procedures have been used for years, but we still need more information about who should be screened and how.

Why did the researchers do this particular study?

Four good studies have found that screening with sigmoidoscopy reduces the number of cases of colorectal cancer and the number of people who die of it. Some of these studies have found a smaller benefit in women than men. However, the differences varied from study to study and according to whether the study outcome was how often cancer occurred or how often cancer resulted in death.

Who was studied?

Almost 100,000 people living in Norway who were 50 to 64 years old and did not have colorectal cancer or symptoms of bowel disease.

How was the study done?

The investigators assigned some people to have sigmoidoscopy and other people not to have sigmoidoscopy. The assignments were done so that the 2 groups had the same types of people.

What did the researchers find?

After 15 years, investigators found that the men who had sigmoidoscopy had fewer cases of colorectal cancer than the men who did not. They also found that fewer of the men who had the procedure died of colorectal cancer. In contrast, the investigators could not identify any benefits of screening women with sigmoidoscopy.

What were the limitations of the study?

The investigators did not have information about some of the risk factors for colorectal cancer or how people were treated after they developed colorectal cancer. In addition, it is difficult to follow so many people for such a long time, and some cases of colorectal cancer could have been missed.

What are the implications of the study?

Current recommendations advise screening women for colorectal cancer using sigmoidoscopy; however, these recommendations may need to be reconsidered.

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Sigmoidoscopy Screening for Colorectal Cancer. Ann Intern Med. 2018;168:I–24. [Epub ahead of print 24 April 2018]. doi: https://doi.org/10.7326/P18-0006

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Published: Ann Intern Med. 2018;168(11):I-24.

DOI: 10.7326/P18-0006

Published at www.annals.org on 24 April 2018

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2018 American College of Physicians
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