Screening sigmoidoscopy in persons aged 60 years

OBJECTIVE: To reduce mortality associated with colorectal cancer, an increased interest has focused in recent years on screening of colorectal cancer. No studies of colorectal cancer screening in Finland has been reported. A pilot study of screening sigmoidoscopy was started in 1994 and the results are presented in this paper.SUBJECTS AND METHODS: Between March 1994 and May 2000 all 1224 persons aged 60 years from four communities (population 15 400) were invited to screening sigmoidoscopy; 896 (73%) took part in this study. The screening procedure was flexible sigmoidoscopy to 60 centimetres. All the patients who had adenomas or cancers, were invited to have a double contrast barium enema (DCBE) or colonoscopy to investigate the proximal colon. To study the experience of persons undergoing screening sigmoidoscopy, a questionnaire was sent to 81 consecutive persons after the examination. Sixty persons (74%) returned the filled-in questionnaire.RESULTS: Hyperplastic polyps were found in 136 people (15.2% of the whole material). Hyperplastic polyps were more common in males than females (19.3% and 11.4%, respectively, P=0.0015). People with hyperplastic polyps had the same rate of neoplasia as people without. Neoplastic lesions were found in 65 people. Adenomas were found in 62 patients (6.9%). Twenty-five people (2.8%) had at least one advanced adenoma (>10 mm or villous component). The rate of advanced adenomas in males was 4.9% and in females 0.9% (P=0.0006). Three patients (0.3%) were found to have colorectal cancer. Of 43 diabetic patients, 7 (16.3%) had adenomas whereas 6.5% of the non-diabetic persons had adenomas (P=0.03). The proximal colon was investigated in 34 patients by DCBE and/or colonoscopy and the rate of proximal adenomas in patients with neoplastic findings in screening sigmoidoscopy was 5/34 (14.7%). Concerning the experience of screening sigmoidoscopy, 56 persons (93%) found bowel preparation easy and 4 unpleasant, 55 (92%) experienced either no or mild discomfort during the endoscopy whereas 5 found the examination painful; 59 people (98%) said that they would participate again in screening sigmoidoscopy.CONCLUSIONS: In this study of screening sigmoidosopy, the first published in Finland, adenoma rate was 6.9%, advanced adenoma rate was 2.8% and cancer rate was 0.3%. Males had more hyperplastic polyps and advanced adenomas than females. Diabetic people had more adenomas than non-diabetics. Experiences of the people screened were positive and nearly all said that they would participate again in screening sigmoidoscopy.