title: Effectiveness of flexible sigmoidoscopy screening in men and women and different age groups: pooled analysis of randomised trials.
abstract: OBJECTIVE
  To compare the effectiveness of flexible sigmoidoscopy in screening for colorectal cancer by patient sex and age.
  
  
  METHODS
  Pooled analysis of randomised trials (the US Prostate, Lung, Colorectal and Ovarian cancer screening trial (PLCO), the Italian Screening for Colon and Rectum trial (SCORE), and the Norwegian Colorectal Cancer Prevention trial (NORCCAP)).
  
  
  METHODS
  Aggregated data were pooled from each randomised trial on incidence of colorectal cancer and mortality stratified by sex, age at screening, and colon subsite (distal v proximal).
  
  
  METHODS
  Invited individuals aged 55-74 (PLCO), 55-64 (SCORE), and 50-64 (NORCCAP). Individuals were randomised to receive flexible sigmoidoscopy screening once only (SCORE and NORCCAP) or twice (PLCO), or receive usual care (no intervention).
  
  
  RESULTS
  287 928 individuals were included in the pooled analysis; 115 139 randomised to screening and 172 789 to usual care. Compliance rates were 58%, 63%, and 87% in SCORE, NORCCAP, and PLCO, respectively. Median follow-up was 10.5 to 12.1 years. Screening reduced the incidence of colorectal cancer in men (relative risk 0.76; 95% confidence interval 0.70 to 0.83) and women (0.83; 0.75 to 0.92). No difference in the effect of screening was seen between men younger than 60 and those older than 60. Screening reduced the incidence of colorectal cancer in women younger than 60 (relative risk 0.71; 95% confidence interval 0.59 to 0.84), but not significantly in those aged 60 or older (0.90; 0.80 to 1.02). Colorectal cancer mortality was significantly reduced in both younger and older men, and in women younger than 60. Screening reduced colorectal cancer incidence to a similar extent in the distal colon in men and women, but there was no effect of screening in the proximal colon in older women with a significant interaction between sex and age group (P=0.04).
  
  
  CONCLUSIONS
  Flexible sigmoidoscopy is an effective tool for colorectal cancer screening in men and younger women. The benefit is smaller and not statistically significant for women aged over 60; alternative screening methods that more effectively detect proximal tumours should be considered for these women.
authors.affiliation: Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway.|Clinical Effectiveness Research group, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Holme
authors.affiliation: Departments of Medicine and Epidemiology, University of Pittsburgh, University of Pittsburgh Cancer Institute, Pittsburgh, PA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schoen
authors.affiliation: Centro di Prevenzione Oncologica Piemonte and Città della Salute e della Scienza University Hospital, Turin, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Senore
authors.affiliation: Centro di Prevenzione Oncologica Piemonte and Città della Salute e della Scienza University Hospital, Turin, Italy.
authors.forename: Nereo
authors.initials: N
authors.lastname: Segnan
authors.affiliation: Telemark Hospital Skien, Skien, Norway.|Cancer Registry of Norway, Oslo, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Hoff
authors.affiliation: Clinical Effectiveness Research group, Institute of Health and Society, University of Oslo, Oslo, Norway.|Department of Transplantation Medicine and KG Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway.
authors.forename: Magnus
authors.initials: M
authors.lastname: Løberg
authors.affiliation: Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway.|Clinical Effectiveness Research group, Institute of Health and Society, University of Oslo, Oslo, Norway.|Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.|Department of Transplantation Medicine and KG Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway.
authors.forename: Michael
authors.initials: M
authors.lastname: Bretthauer
authors.affiliation: Clinical Effectiveness Research group, Institute of Health and Society, University of Oslo, Oslo, Norway.|Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Hans-Olov
authors.initials: HO
authors.lastname: Adami
authors.affiliation: Clinical Effectiveness Research group, Institute of Health and Society, University of Oslo, Oslo, Norway.|Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.|Department of Transplantation Medicine and KG Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway.
authors.forename: Mette
authors.initials: M
authors.lastname: Kalager
mesh_terms: D017677:Age Distribution; D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000401:mortality; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D017678:Sex Distribution; D012812:Sigmoidoscopy