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21-05-2012 | General practice | Article

Flexi-sig screening supported

Abstract

NEJM

2012; Advance online publication

MedWire News: Results of a large US trial support the benefits of routine flexible sigmoidoscopy (or 'flexi-sig') screening for the prevention of deaths from colorectal cancer.

The study included over 150,000 men and women aged 55-74 years and showed that routine flexi-sig screening reduced colorectal cancer mortality by one quarter, and the incidence of colorectal cancer by one fifth.

Between 1993 and 2001, the participants were randomly assigned to undergo routine flexi-sig screening, with repeat screening at 3 or 5 years, or to receive usual care in which they only underwent flexi-sig screening if they requested it, or on the recommendation of their doctor.

The results were presented by Dr Christine Berg, from the US National Cancer Institute (NCI), and colleagues at the Digestive Disease Week conference and are published online in the New England Journal of Medicine. Over 12 years of follow-up, there were 2.9 deaths from colorectal cancer per 10,000 person-years in the screening group, compared with 3.9 per 10,000 person-years in the usual-care group.

Flexible sigmoidoscopy screening is currently being piloted in the UK, with a view to full roll-out and screening of all adults once they reach the age of 55 by 2016. Experts believe it could save an additional 3000 lives each year in the UK.

The mortality benefit in the current trial was limited to cancer of the distal colon, for which there was a 50% reduction in deaths; although the incidence of cancer of the proximal colon was reduced, no mortality benefit was seen. However, it remains uncertain colonoscopy offers any advantage in terms of reducing proximal colon cancer mortality.

"This is the second major trial that has shown that sigmoidoscopy is effective in reducing the risk of dying of colorectal cancer. Sigmoidoscopy is less invasive than colonoscopy and carries a lower risk of the colon being perforated, which may make it more acceptable as a screening test to some patients," commented Barrett Kramer, director of the NCI's Division of Cancer Prevention.

MedWire News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Caroline Price