According to evidence from four randomized studies, sigmoidoscopy screening decreases the long-term incidence of colorectal cancer (CRC) and death.
According to Frederik Juul, MD, of Oslo University Hospital in Norway, and colleagues, the cumulative incidence of CRC at 15 years was 21% lower among those invited to screening compared to a group that received usual care, at 1.84 versus 2.35 cases per 100 people (incidence rate ratio [IRR] 0.79, 95% CI 0.75-0.83).
The screening group also had decreased CRC-specific mortality, with 0.51 against 0.65 deaths per 100 people, resulting to a 20% reduction over 15 years (mortality rate ratio [MRR] 0.80, 95% CI 0.72-0.88).
Benefits of screening were consistent across starting age (55-64 years in the studies), were more apparent in men, and were mainly confined to cancers of the distal colon, the authors wrote in Annals of Internal Medicine.
“The long-term benefit of one single procedure was probably what surprised us the most,” Juul told MedPage Today. “Not only were the cumulative incidence and mortality lower in screened individuals 15 years after the procedure, but the yearly incidence was consistently lower in screened individuals (compared to usual care) even at the end of the follow-up period.”
All-cause mortality was also significantly lower, the group found, at 14.3 deaths per 100 persons in the screening group versus 14.6 deaths per 100 persons with usual care (MRR 0.98, 95% CI 0.95-1.00, P=0.016).
The study “helps further our narrative that screening is an important tool and that it helps identify colorectal cancers early, which is the ideal,” Allen Kamrava, MD, of Cedars-Sinai Medical Center in Los Angeles, told MedPage Today.
“However, the study focuses on sigmoidoscopy, and does it without regard to newer methods of screening, including DNA fecal immunochemical test (FIT), which are being used more and more,” said Kamrava, who was not involved in the study. “Overall, it confirms what we all know — that screening works — but I believe it runs the risk of prioritizing sigmoidoscopies over colonoscopies and FIT testing.”
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