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Reduction in colon cancer mortality greater for colonoscopy than sigmoidoscopy
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Sigmoidoscopy and colonoscopy both reduced overall colorectal cancer mortality and incidence of distal colorectal cancer, but only colonoscopy was associated with reduced incidence of and mortality from proximal colon cancer, according to study results.
“Large-scale clinical trials have shown that sigmoidoscopy reduces the overall incidence of colorectal cancer and of deaths from the disease, although its effectiveness is greatest in the distal colon,” co-senior researcher Shuji Ogino, MD, PhD, of Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School and Harvard School of Public Health, said in a press release. “Although data from similar trials of colonoscopy are not yet available, the existing evidence suggests that it, too, is associated with lower rates of colorectal cancer. In the current study, we set out to measure how much protection sigmoidoscopy and colonoscopy provide and for how long, particularly for cancers originating in the proximal colon.”
Shuji Ogino
To examine the association of lower endoscopy use with colorectal cancer incidence, Ogino and colleagues analyzed data from 88,902 individuals enrolled in the Nurses’ Health Study and the Health Professionals Follow-up Study.
During 22 years of follow-up, researchers identified 1,815 incident cases of colorectal cancer and 474 deaths from colorectal cancer.
Negative colonoscopy was associated with a reduced incidence of proximal colon cancer (multivariate HR=0.73; 95% CI, 057-0.92). Multivariate HRs for death from colorectal cancer were 0.59 (95% CI, 0.45-0.76) after screening sigmoidoscopy and 0.32 (95% CI, 0.24-0.45) after screening colonoscopy.
In addition, researchers observed reduced mortality from proximal colon cancer after screening colonoscopy (multivariate HR=0.47; 95% CI, 0.29-0.76) but not after sigmoidoscopy.
“This study provides some of the clearest evidence to date that colonoscopy has advantages over sigmoidoscopy for the prevention of colorectal cancer, although it is not a perfect test,” co-senior researcher Andrew T. Chan, MD, MPH, of the Massachusetts General Hospital Gastrointestinal Unit, said in a press release.
“For individual patients, the decision to select colonoscopy over sigmoidoscopy for colorectal cancer screening requires discussing with their physicians how the advantages and disadvantages of each test apply to their personal situations,” Chan said. “Right now our data support the use of colonoscopy if the primary goal is maximum risk reduction for both left- and right-side colorectal cancers.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.
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