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Colorectal-Cancer Incidence and Mortality with Screening Flexible Sigmoidoscopy
Open accessAbstract
BACKGROUND: The benefits of endoscopic testing for colorectal-cancer screening are uncertain. We evaluated the effect of screening with flexible sigmoidoscopy on colorectal-cancer incidence and mortality. METHODS: From 1993 through 2001, we randomly assigned 154,900 men and women 55 to 74 years of age either to screening with flexible sigmoidoscopy, with a repeat screening at 3 or 5 years, or to usual care. Cases of colorectal cancer and deaths from the disease were ascertained. RESULTS: Of the 77,445 participants randomly assigned to screening (intervention group), 83.5% underwent baseline flexible sigmoidoscopy and 54.0% were screened at 3 or 5 years. The incidence of colorectal cancer after a median follow-up of 11.9 years was 11.9 cases per 10,000 person-years in the intervention group (1012 cases), as compared with 15.2 cases per 10,000 person-years in the usual-care group (1287 cases), which represents a 21% reduction (relative risk, 0.79; 95% confidence interval [CI], 0.72 to 0.85; P<0.001). Significant reductions were observed in the incidence of both distal colorectal cancer (479 cases in the intervention group vs. 669 cases in the usual-care group; relative risk, 0.71; 95% CI, 0.64 to 0.80; P<0.001) and proximal colorectal cancer (512 cases vs. 595 cases; relative risk, 0.86; 95% CI, 0.76 to 0.97; P=0.01). There were 2.9 deaths from colorectal cancer per 10,000 person-years in the intervention group (252 deaths), as compared with 3.9 per 10,000 person-years in the usual-care group (341 deaths), which represents a 26% reduction (relative risk, 0.74; 95% CI, 0.63 to 0.87; P<0.001). Mortality from distal colorectal cancer was reduced by 50% (87 deaths in the intervention group vs. 175 in the usual-care group; relative risk, 0.50; 95% CI, 0.38 to 0.64; P<0.001); mortality from proximal colorectal cancer was unaffected (143 and 147 deaths, respectively; relative risk, 0.97; 95% CI, 0.77 to 1.22; P=0.81). CONCLUSIONS: Screening with flexible sigmoidoscopy was associated with a significant decrease in colorectal-cancer incidence (in both the distal and proximal colon) and mortality (distal colon only). (Funded by the National Cancer Institute; PLCO ClinicalTrials.gov number, NCT00002540.).
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Cited by
Wolf, A. M. D., Fontham, E. T. H., Church, T. R., Flowers, C. R., Guerra, C. E., LaMonte, S. J., Etzioni, R., McKenna, M. T., Oeffinger, K. C., Shih, Y. T., et al. (2018) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21457 · Cited by 1,944
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Nishihara, R., Wu, K., Lochhead, P., Morikawa, T., Liao, X., Qian, Z. R., Inamura, K., Kim, S. A., Kuchiba, A., Yamauchi, M., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1301969 · Cited by 1,483
Colorectal cancer screening: a global overview of existing programmes
Schreuders, E. H., Ruco, A., Rabeneck, L., Schoen, R. E., Sung, J. J. Y., Young, G. P., & Kuipers, E. J. (2015) · Gut · doi:10.1136/gutjnl-2014-309086 · Cited by 1,328
Self-citationLin, J. S., Bowles, E. J. A., Williams, S. B., & Morrison, C. C. (2017) · JAMA · doi:10.1001/jama.2017.0562 · Cited by 1,082
Jacobs, I. J., Menon, U., Ryan, A., Gentry-Maharaj, A., Burnell, M., Kalsi, J. K., Amso, N. N., Apostolidou, S., Benjamin, E., Cruickshank, D., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(15)01224-6 · Cited by 1,048
Metadata
- Authors
- Schoen, R. E., Pinsky, P. F., Weissfeld, J. L., Yokochi, L. A., Church, T., Laiyemo, A. O., Bresalier, R., Andriole, G. L., Buys, S. S., Crawford, E. D., Fouad, M. N., Isaacs, C., Johnson, C. C., Reding, D. J., O'Brien, B., Carrick, D. M., Wright, P., Riley, T. L., Purdue, M. P., Izmirlian, G., Kramer, B. S., Miller, A. B., Gohagan, J. K., Prorok, P. C., & Berg, C. D.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-06-21
- Volume
- 366
- Issue
- 25
- Pages
- 2345-2357
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2147579615
- Cited by
- 1,021
- References
- 0
- FWCI
- 50.85
- Type
- journal article
- Language
- en
- Open access
- bronze
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- Schoen, R. E., Pinsky, P. F., Weissfeld, J. L., Yokochi, L. A., Church, T., Laiyemo, A. O., Bresalier, R., Andriole, G. L., Buys, S. S., Crawford, E. D., Fouad, M. N., Isaacs, C., Johnson, C. C., Reding, D. J., O'Brien, B., Carrick, D. M., Wright, P., Riley, T. L., Purdue, M. P., . . . Berg, C. D. (2012). Colorectal-Cancer Incidence and Mortality with Screening Flexible Sigmoidoscopy. New England Journal of Medicine. https://doi.org/10.1056/nejmoa1114635
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Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
