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.

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