Robert Jc Steele1,2, Francis A Carey3, Greig Stanners4, Jaroslaw Lang4, Jess Brand5, Linda A Brownlee2, Emilia M Crichton6, Jack W Winter7, Perminder S Phull8, Craig Mowat9, Judith A Strachan10, Ann-Marie Digan2, Callum G Fraser1. 1. Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK. 2. Scottish Bowel Screening Centre, NHS Tayside, Kings Cross Hospital, Dundee, UK. 3. Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK. 4. Quality Indicators, NHS National Services Scotland, Glasgow, UK. 5. National Specialist and Screening Services Directorate, Edinburgh, UK. 6. Public Health Directorate, NHS Greater Glasgow and Clyde, Glasgow, UK. 7. Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK. 8. Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK. 9. Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK. 10. Department of Blood Sciences and Scottish Bowel Screening Laboratory, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.
Abstract
OBJECTIVES:Flexible sigmoidoscopy screening at around age 60 can reduce colorectal cancer incidence. Insufficient evidence exists on flexible sigmoidoscopyat age 60 in a population being offered biennial faecal occult blood test screening from age 50. This randomized controlled trial assessed if flexible sigmoidoscopy would be an effective adjunct to faecal occult blood test. METHODS:In the Scottish Bowel Screening Programme between June 2014 and December 2015, 51,769 individuals were randomized to be offered flexible sigmoidoscopy instead of faecal occult blood test at age 60 or to continue faecal occult blood test. Those not accepting flexible sigmoidoscopy and those with normal flexible sigmoidoscopy were offered faecal occult blood test. All with flexible sigmoidoscopy-detected neoplasia or a positive faecal occult blood test result were offered colonoscopy. RESULTS:Overall flexible sigmoidoscopy uptake was 17.8%, higher in men than women, and decreased with increasing deprivation (25.7% in the least to 9.2% in the most deprived quintile). In those who underwent flexible sigmoidoscopy, detection rate for colorectal cancer was 0.13%, for adenoma 7.27%, and for total neoplasia 7.40%. In those who underwent colonoscopy after a positive flexible sigmoidoscopy, detection rate for colorectal cancer was 0.28%, adenoma 8.66%, and total neoplasia 8.83%. On an intention to screen basis, there was no difference in colorectal cancer detection rate between the study and control groups. Adenoma and total neoplasia detection rate were significantly higher in the study group, with odds ratios of 5.95 (95%CI: 4.69-7.56) and 5.10 (95%CI: 4.09-6.35), respectively. CONCLUSIONS: In a single screening round at age 60, there was low uptake and neoplasia detection rate. Flexible sigmoidoscopy detected significantly more neoplasia than faecal occult blood test alone.
RCT Entities:
OBJECTIVES: Flexible sigmoidoscopy screening at around age 60 can reduce colorectal cancer incidence. Insufficient evidence exists on flexible sigmoidoscopy at age 60 in a population being offered biennial faecal occult blood test screening from age 50. This randomized controlled trial assessed if flexible sigmoidoscopy would be an effective adjunct to faecal occult blood test. METHODS: In the Scottish Bowel Screening Programme between June 2014 and December 2015, 51,769 individuals were randomized to be offered flexible sigmoidoscopy instead of faecal occult blood test at age 60 or to continue faecal occult blood test. Those not accepting flexible sigmoidoscopy and those with normal flexible sigmoidoscopy were offered faecal occult blood test. All with flexible sigmoidoscopy-detected neoplasia or a positive faecal occult blood test result were offered colonoscopy. RESULTS: Overall flexible sigmoidoscopy uptake was 17.8%, higher in men than women, and decreased with increasing deprivation (25.7% in the least to 9.2% in the most deprived quintile). In those who underwent flexible sigmoidoscopy, detection rate for colorectal cancer was 0.13%, for adenoma 7.27%, and for total neoplasia 7.40%. In those who underwent colonoscopy after a positive flexible sigmoidoscopy, detection rate for colorectal cancer was 0.28%, adenoma 8.66%, and total neoplasia 8.83%. On an intention to screen basis, there was no difference in colorectal cancer detection rate between the study and control groups. Adenoma and total neoplasia detection rate were significantly higher in the study group, with odds ratios of 5.95 (95%CI: 4.69-7.56) and 5.10 (95%CI: 4.09-6.35), respectively. CONCLUSIONS: In a single screening round at age 60, there was low uptake and neoplasia detection rate. Flexible sigmoidoscopy detected significantly more neoplasia than faecal occult blood test alone.
Authors: Edoardo Botteri; Geir Hoff; Kristin R Randel; Øyvind Holme; Thomas de Lange; Tomm Bernklev; Eline Aas; Mona Berthelsen; Erik Natvig; Benedicte Kirkøen; Markus D Knudsen; Ane S Kvaerner; Anna L Schult; Giske Ursin; Anita Jørgensen; Paula Berstad Journal: Int J Cancer Date: 2022-04-22 Impact factor: 7.316