Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy.

Abstract

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.).

DOI: 10.1056/NEJMoa1114635

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@article{Schoen2012ColorectalcancerIA, title={Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy.}, author={Robert E. Schoen and Paul F. Pinsky and Joel L. Weissfeld and Lance A. Yokochi and Timothy Church and Adeyinka O. Laiyemo and Robert S. Bresalier and Gerald L. Andriole and Saundra S. Buys and E. David Crawford and Mona Fouad and Claudine J Isaacs and Christine C. Johnson and Douglas J. Reding and Barbara O'Brien and Danielle Mercatante Carrick and Patrick Wright and Thomas L. Riley and Mark P H Purdue and Grant Izmirlian and Barnett S. Kramer and Anthony B. Miller and John K. Gohagan and Philip C Prorok and Christine D. Berg}, journal={The New England journal of medicine}, year={2012}, volume={366 25}, pages={2345-57} }