Long-Term Effectiveness of Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality in Women and Men: A Randomized Trial
Holme, Øyvind; Løberg, Magnus; Kalager, Mette; Bretthauer, Michael; Hernan, Miguel A.; Aas, Eline; Eide, Tor Jacob; Skovlund, Eva; Lekven, Jon; Schneede, Jørn; Tveit, Magne Kjell; Vatn, Morten H; Ursin, Giske; Hoff, Geir
Journal article, Peer reviewed
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Date
2018Metadata
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Abstract
Background:
The long-term effects of sigmoidoscopy screening on colorectal cancer (CRC) incidence and mortality in women and men are unclear.
Objective:
To determine the effectiveness of flexible sigmoidoscopy screening after 15 years of follow-up in women and men.
Design:
Randomized controlled trial. (ClinicalTrials.gov: NCT00119912)
Setting:
Oslo and Telemark County, Norway.
Participants:
Adults aged 50 to 64 years at baseline without prior CRC.
Intervention:
Screening (between 1999 and 2001) with flexible sigmoidoscopy with and without additional fecal blood testing versus no screening. Participants with positive screening results were offered colonoscopy.
Measurements:
Age-adjusted CRC incidence and mortality stratified by sex.
Results:
Of 98 678 persons, 20 552 were randomly assigned to screening and 78 126 to no screening. Adherence rates were 64.7% in women and 61.4% in men. Median follow-up was 14.8 years. The absolute risks for CRC in women were 1.86% in the screening group and 2.05% in the control group (risk difference, −0.19 percentage point [95% CI, −0.49 to 0.11 percentage point]; HR, 0.92 [CI, 0.79 to 1.07]). In men, the corresponding risks were 1.72% and 2.50%, respectively (risk difference, −0.78 percentage point [CI, −1.08 to −0.48 percentage points]; hazard ratio [HR], 0.66 [CI, 0.57 to 0.78]) (P for heterogeneity = 0.004). The absolute risks for death from CRC in women were 0.60% in the screening group and 0.59% in the control group (risk difference, 0.01 percentage point [CI, −0.16 to 0.18 percentage point]; HR, 1.01 [CI, 0.77 to 1.33]). The corresponding risks for death from CRC in men were 0.49% and 0.81%, respectively (risk difference, −0.33 percentage point [CI, −0.49 to −0.16 percentage point]; HR, 0.63 [CI, 0.47 to 0.83]) (P for heterogeneity = 0.014).
Limitation:
Follow-up through national registries.
Conclusion:
Offering sigmoidoscopy screening in Norway reduced CRC incidence and mortality in men but had little or no effect in women.