Incomplete screening flexible sigmoidoscopy associated with female sex, age, and increased risk of colorectal cancer.
BACKGROUND
Several previous studies have found that females and older individuals are at greater risk of having incomplete flexible sigmoidoscopy. However, no prior study has reported the subsequent risk of colorectal cancer (CRC) following incomplete sigmoidoscopy.


METHODS
Using data from 55 791 individuals screened as part of the Colon Cancer Prevention (CoCaP) programme of Kaiser Permanente of Northern California, we evaluated the likelihood of having an inadequate (<40 cm) examination by age and sex, and estimated the risk of distal CRC according to depth of sigmoidoscope insertion at the baseline screening examination. Multivariate estimation of risks was performed using Poisson regression.


RESULTS
Older individuals were at a much greater risk of having an inadequate examination (relative risk (RR) for age 80+ years compared with 50-59 years 2.6 (95% confidence interval (CI) 2.3-3.0)), as were females (RR 2.3 (95% CI 2.2-2.5)); these associations were attenuated but remained strong if Poisson models were further adjusted for examination limitations (pain, stool, and angulation). There was an approximate threefold increase in the risk of distal CRC if the baseline sigmoidoscopy did not reach a depth of at least 40 cm; a smaller increase in risk was observed for examinations that reached 40-59 cm.


CONCLUSIONS
Older individuals and women are at an increased risk of having inadequate sigmoidoscopy. Because inadequate sigmoidoscopy results in an increased risk of subsequent CRC, physicians should consider steps to maximise the depth of insertion of the sigmoidoscope or, failing this, should consider an alternative screening test.
Doria-Rose
V P
VP
Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, M4-B402, PO Box 19024, Seattle, Washington 98109-1024, USA. pdoriaro@fhcrc.org
Newcomb
P A
PA
Levin
T R
TR
D000367:Age Factors; D000369:Aged, 80 and over; D003106:Colon / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012306:Risk; D012737:Sex Factors; D012811:Sigmoid Neoplasms / Q000175:diagnosis; D017211:Treatment Failure