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Single flexible sigmoidoscopy reduced colorectal cancer incidence, mortality rates
Segnan N. J Natl Cancer Inst. 2011;doi:10.1093/jnci/djr284.
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Results from the SCORE trial revealed that a single flexible sigmoidoscopy screening in those aged 55 to 64 years was associated with a reduction in colorectal cancer incidence and mortality, further confirming the results of the UK Flexible Sigmoidoscopy Screening Trial.
In the randomized controlled SCORE trial, researchers mailed a questionnaire to 236,568 men and women aged 55 to 64 years who had been randomly selected from six trial centers in Italy to assess eligibility and interest in screening. Researchers then randomly assigned interested and eligible respondents to the intervention group or the control group (n=17,136 in each group). Respondents in the intervention group were invited to undergo flexible sigmoidoscopy, and 9,911 of these respondents underwent sigmoidoscopy. Researchers had no further contact with those in the control group.
Median follow-up was 10.5 years for incidence and 11.4 years for mortality. Follow-up involved automatic record linkage of the trial database with regional hospital discharge records and pathology department files every 2 years. Two hundred fifty-one respondents in the intervention group and 306 in the control group were diagnosed with colorectal cancer. Researchers reported a detection rate of 5.4/1,000 participants and overall incidence rates of 144.11/100,000 person-years in the intervention group and 176.43/100,000 person-years in the control group.
Sixty-five respondents in the intervention group and 83 in the control group died of colorectal cancer, yielding mortality rates of 34.66/100,000 person-years in the intervention group and 44.45 in the control group.
Based on an intention-to-treat analysis, the researchers found an 18% reduction in colorectal cancer incidence and a 22% reduction in mortality rate in the intervention group, although the reduction in mortality was not statistically significant. In a per-protocol analysis, both incidence and mortality rates were statistically significantly reduced in the intervention group — a 31% reduction in incidence and a 38% reduction in mortality.
When looking only at colorectal cancer incidence in the distal colon, researchers found a 40% reduction. They also reported a 46% incidence reduction for advanced colorectal cancer cases.
“Now, we can confidently assert that a single flexible sigmoidoscopy examination is an effective method of screening for colorectal cancer,” Timothy R. Church, PhD, of the division of environmental health sciences at the University of Minnesota, said in an editorial accompanying the study. “Given that the best evidence to date does not suggest a large difference in effectiveness of the three main approaches to colorectal cancer screening, the US approach of recommending all three screening strategies seems sound. Any concerns about the potential confusion that arises from multiple approaches may be balanced by the advantages of tailoring screening to the preferences of the patient.”
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