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Flexible sigmoidoscopy screening reduced colorectal cancer incidence, mortality
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Once-only flexible sigmoidoscopy screening with or without fecal occult blood testing was associated with reduced colorectal cancer incidence and mortality, according to results of a population-based study.
The analysis included 98,792 members of the general population of Norway. Researchers randomly assigned participants to no screening (n=78,220) or screening (n=20,572).
Those assigned screening were randomly assigned to receive once-only flexible sigmoidoscopy alone (n=10,283) or once-only flexible sigmoidoscopy plus fecal occult blood testing (FOBT; n=10,298).
Participants aged 55 to 64 years underwent screening between 1999 and 2000, and participants aged 50 to 54 years underwent screening in 2001.
Sixty-three percent of participants assigned screening underwent the examination (sigmoidoscopy plus FOBT, 60.9%; flexible sigmoidoscopy alone, 65.1%; P˂.001).
Median follow-up was 10.9 years in the control arm and 11.2 years in the screening arm.
The colorectal cancer incidence rate was 112.6 per 100,000 person-years in the screening arm and 141 per 100,000 person-years in the control arm (HR=0.8; 95% CI, 0.7-0.92). Colorectal cancer incidence in the screening arm was reduced among those aged 50 to 54 years (HR=0.68; 95% CI, 0.49-0.94) and those aged 55 to 64 years (HR=0.83; 95% CI, 0.71-0.96).
A lower percentage of patients assigned screening vs. no screening died from colorectal cancer (31.4 deaths per 100,000 person-years vs. 43.1 deaths per 100,000 person-years; HR=0.73; 95% CI, 0.56-0.94). Screening was associated with reduced colorectal cancer mortality for participants aged 50 to 54 years (HR=0.74; 95% CI, 0.40-1.35) and those aged 55 to 64 years (HR=0.73; 95% CI, 0.55-0.97).
Allan S. Brett
Researchers observed the reduced risk for colorectal cancer associated with screening regardless if screening was conducted with flexible sigmoidoscopy alone (HR=0.84; 95% CI, 0.61-1.17) or in combination with FOBT (HR=0.62; 95% CI, 0.42-0.9).
Although randomized controlled trial data suggest FOBT and flexible sigmoidoscopy are effective, colonoscopy remains the standard colorectal cancer screening practice in the United States, Allan S. Brett, MD, of the University of South Carolina School of Medicine, wrote in an accompanying editorial. However, the introduction of stool DNA testing may soon factor into the equation, he wrote.
“Repeated at some defined interval, stool DNA testing has potential to reduce colorectal cancer mortality substantially while sharply reducing the number of routine colonoscopies,” Brett wrote. “For now, however, the muddled landscape of colorectal cancer screening in the United States continues, and the place of flexible sigmoidoscopy among screening tools remains unsettled.”
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Disclosure: One researcher reports a scientific advisory board role with Exact Sciences and receipt of equipment for scientific testing from CSS Healthcare, Falk Group, Fujinon and Olympus. Brett reports no relevant financial disclosures.