Advertisement

Flexible Sigmoidoscopy Cuts Colorectal Cancer Incidence, Mortality — Physician’s First Watch

Medical News |
August 13, 2014

Flexible Sigmoidoscopy Cuts Colorectal Cancer Incidence, Mortality

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

One-time screening with flexible sigmoidoscopy reduces colorectal cancer incidence and mortality, a JAMA study finds.

Some 100,000 adults aged 50 to 64 in Norway were randomized to undergo one-time screening flexible sigmoidoscopy (with or without fecal occult blood testing [FOBT]) or no intervention. Colonoscopy was offered to those with positive screens.

During roughly 11 years' follow-up, colorectal cancer deaths were reduced significantly in the screening group versus the control group (31.4 vs. 43.1 deaths per 100,000 person-years), as were colorectal cancer diagnoses (112.6 vs. 141.0 cases per 100,000 person-years). Findings were similar whether screening did or did not include FOBT.

In a JAMA editorial, NEJM Journal Watch General Medicine editor-in-chief Allan Brett notes that sigmoidoscopy screening "has all but vanished" in the U.S., largely replaced by colonoscopy — even though "randomized trial-level evidence of reduced cancer-specific mortality exists for flexible sigmoidoscopy and FOBT but not for colonoscopy." He then examines the "quandaries" that U.S. primary care clinicians face as they navigate the many colorectal screening options and recommendations, and notes that stool DNA testing may change the conversation substantially.

Reader Comments (4)

philip cohen Mb ChB (Cape) FRCS (Edin) FCS (SA) Physician, Surgery, General, retired

It was apparent over many years in surgery that many, if not most, CRC tumours were within reach of a rigid sigmoidoscope (30 cm). How much better with a flexible siggy (60 cm)!
So the findings are not at all unexpected.
And without the inevitable complication rate of completion right-sided colonoscopy.

Norman Sohn, M.D., MBA Physician, Surgery, Specialized, Teaneck, New Jersey

Sigmoidoscopy as screening for colorectal cancer has been compared to mammography on a single breast. You can miss half the cases.

Sheldon Ball MD, PhD Physician, Geriatrics, Anvita Health

It is refreshing to see a rare reference to financial incentive int the editorial. I was hoping to see some reconciliation with the observation that half of colon carcinomas are right sided.

David La Rochelle MD Physician, Orthopedics, Retired-volunteer only

My colonoscopy at age 57 was positive for adenocarcinoma in the sigmoid colon at 18 cm. During my general surgery follow up consult, the surgeon decided to do a flexible sigmoidoscopy in her office to mark the tumor with ink for location at surgery. She did not locate the tumor for marking. This article should compare both procedures for accuracy as well as limitations.

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement