Possible advantages and drawbacks of adding flexible sigmoidoscopy to hemoccult-II in screening for colorectal cancer. A randomized study.
BACKGROUND
Flexible sigmoidoscopy (FS) has been recommended as a screening method to reduce mortality from colorectal cancer (CRC). The present study evaluates the effect of adding FS to the fecal occult blood test Hemoccult-II (H-II) on diagnostic yield of colorectal neoplasia.


METHODS
A total of 10,978 normal persons aged 50-75 years were invited to participate, 5495 persons being allocated at random to H-II and FS and 5483 to H-II alone.


RESULTS
In spite of a lower compliance (40% versus 56%) for the combined procedure, the diagnostic yield of colorectal neoplasia was higher than for H-II alone (12 CRC versus 4 CRC, and 72 large adenomas versus 14). Within 24-62 months after screening there were fewer CRCs detected after H-II + FS than after H-II alone. The stage distribution was less favorable than in screen-detected cases.


CONCLUSIONS
One FS may not be an optimal way of screening, but FS deserves to be evaluated in randomized population studies including repeated H-II tests in the control arm.
Dept. of Surgery A, Odense University Hospital, Denmark.
M
M
Rasmussen
O
O
Kronborg
C
C
Fenger
O D
OD
Jørgensen
D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009098:Multiphasic Screening / Q000379:methods*; D009780:Occult Blood; D010349:Patient Compliance; D011237:Predictive Value of Tests; D012812:Sigmoidoscopy