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Twenty-Three-Year Benefits of Sigmoidoscopy Screening for Colorectal Cancer : A Randomized Trial
Edoardo Botteri1, Øyvind Holme2, Magnus Løberg3
1Department of Colorectal Cancer Screening and Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway (E.B.).
Background:
Meta-analyses of randomized trials have shown that sigmoidoscopy screening reduces colorectal cancer (CRC) incidence and death for 15 years.
Objective:
To report the benefits of sigmoidoscopy after 23 years.
Design:
Randomized controlled trial. (NORCCAP [Norwegian Colorectal Cancer Prevention], ClinicalTrials.gov: NCT00119912).
Setting:
Population of Oslo and Telemark County, Norway.
Participants:
Persons aged 50 to 64 years without CRC at randomization.
Intervention:
Screening with once-only sigmoidoscopy, with or without 1 fecal immunochemical test, or no screening.
Measurements:
Colorectal cancer incidence and death.
Results:
A total of 100 210 persons were randomly assigned, and 98 654 were included in intention-to-screen analyses: 20 552 in the screening group and 78 102 in the no-screening group. Participation with screening was 61.4% in men and 64.7% in women. In men, the 23-year cumulative risk for CRC was 4.3% in the screening group and 6.0% in the no-screening group, corresponding to a risk difference of -1.7 percentage points (95% CI, -2.2 to -1.2 percentage points). In women, the corresponding risks were 4.2% and 4.7%, yielding a risk difference of -0.5 percentage points (CI, -1.0 to -0.01 percentage points). In men, the 23-year cumulative risk for CRC death was 1.4% in the screening group and 2.2% in the no-screening group, corresponding to a risk difference of -0.8 percentage points (CI, -1.1 to -0.5 percentage points). In women, the corresponding risks were 1.3% and 1.4%, yielding a risk difference of -0.1 percentage points (CI, -0.3 to 0.1 percentage points). The effect was strongest for rectosigmoid cancer. The addition of fecal blood testing to sigmoidoscopy did not change screening benefits.
Limitation:
Follow-up through national registries.
Conclusion:
Offering sigmoidoscopy screening in Norway reduced CRC incidence more in men than in women and reduced CRC death only in men.
Primary Funding Source:
Norwegian government and Norwegian Cancer Society.
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