Screening flexible sigmoidoscopy versus colonoscopy for reduction of colorectal cancer mortality
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Colonoscopy and flexible sigmoidoscopy are both recommended colorectal cancer (CRC) screening strategies, but their relative effectiveness is unclear. We sought to evaluate the ability of each of these two modalities to reduce CRC mortality.
We conducted a case-control study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Cases were persons aged 70–85 years who died of CRC and were matched to up to three non-CRC controls. Receipt of endoscopy was ascertained from Medicare claims and endoscopy indication assigned using a validated algorithm. Conditional logistic regression models were developed to estimate the association between screening colonoscopy or sigmoidoscopy and CRC mortality. We conducted secondary analyses by race, sex, and endoscopist characteristics, and with varying duration of the look-back period.
In the initial analysis using all available look-back years, screening flexible sigmoidoscopy was associated with a 35% reduction in CRC mortality (OR 0.65, 95% CI 0.48, 0.89), while screening colonoscopy was associated with a 74% reduction (OR 0.26, 95% CI 0.23, 0.30). Sigmoidoscopy was not associated with any reduction in proximal CRC mortality. The association between colonoscopy and reduced CRC mortality was stronger in the distal than the proximal colon. Results were similar in analyses using a 5-year look-back period.
Screening colonoscopy was associated with greater reductions in CRC mortality than screening sigmoidoscopy, and with a greater reduction in the distal than the proximal colon. These results provide additional information on the relative benefits of screening for CRC with sigmoidoscopy and colonoscopy.
KeywordsColorectal neoplasm Mass screening Colonoscopy Sigmoidoscopy Case-control studies
- 1.Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte S, Etzioni R, McKenna M, Oeffinger KC, Shih YT, Walter LC, Andrews KS, Brawley OW, Brooks D, Fedewa SA, Manassaram-Baptiste D, Siegel RL, Wender RC, Smith RA (2018) Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin 68:250–281CrossRefGoogle Scholar
- 6.Nishihara R, Wu K, Lochhead P, Morikawa T, Liao X, Qian ZR, Inamura K, Kim SA, Kuchiba A, Yamauchi M, Imamura Y, Willett WC, Rosner BA, Fuchs CS, Giovannucci E, Ogino S, Chan AT (2013) Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 369:1095–1105CrossRefGoogle Scholar
- 12.Schoen RE, Pinsky PF, Weissfeld JL, Yokochi LA, Church T, Laiyemo AO, Bresalier R, Andriole GL, Buys SS, Crawford ED, Fouad MN, Isaacs C, Johnson CC, Reding DJ, O'Brien B, Carrick DM, Wright P, Riley TL, Purdue MP, Izmirlian G, Kramer BS, Miller AB, Gohagan JK, Prorok PC, Berg CD, PLCO Project Team (2012) Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med 366:2345–2357CrossRefGoogle Scholar
- 13.Segnan N, Armaroli P, Bonelli L, Risio M, Sciallero S, Zappa M, Andreoni B, Arrigoni A, Bisanti L, Casella C, Crosta C, Falcini F, Ferrero F, Giacomin A, Giuliani O, Santarelli A, Visioli CB, Zanetti R, Atkin WS, Senore C, and the SCORE Working Group (2011) Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian randomized controlled trial--SCORE. J Natl Cancer Inst 103:1310–1322CrossRefGoogle Scholar
- 16.Quintero E, Castells A, Bujanda L, Cubiella J, Salas D, Lanas Á, Andreu M, Carballo F, Morillas JD, Hernández C, Jover R, Montalvo I, Arenas J, Laredo E, Hernández V, Iglesias F, Cid E, Zubizarreta R, Sala T, Ponce M, Andrés M, Teruel G, Peris A, Roncales MP, Polo-Tomás M, Bessa X, Ferrer-Armengou O, Grau J, Serradesanferm A, Ono A, Cruzado J, Pérez-Riquelme F, Alonso-Abreu I, de la Vega-Prieto M, Reyes-Melian JM, Cacho G, Díaz-Tasende J, Herreros-de-Tejada A, Poves C, Santander C, González-Navarro A, COLONPREV Study Investigators (2012) Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med 366:697–706CrossRefGoogle Scholar
- 18.Dominitz JA, Robertson DJ, Ahnen DJ, Allison JE, Antonelli M, Boardman KD, Ciarleglio M, del Curto BJ, Huang GD, Imperiale TF, Larson MF, Lieberman D, OʼConnor T, OʼLeary TJ, Peduzzi P, Provenzale D, Shaukat A, Sultan S, Voorhees A, Wallace R, Guarino PD (2017) Colonoscopy vs. fecal immunochemical test in reducing mortality from colorectal cancer (CONFIRM): rationale for study design. Am J Gastroenterol 112:1736–1746CrossRefGoogle Scholar
- 21.SEER Program Overview. Available from: http://healthcaredelivery.cancer.gov/seermedicare/overview/. Accessed June 1, 2018
- 23.Schenck AP, Klabunde CN, Warren JL, Peacock S, Davis WW, Hawley ST, Pignone M, Ransohoff DF (2008) Evaluation of claims, medical records, and self-report for measuring fecal occult blood testing among medicare enrollees in fee for service. Cancer Epidemiol Biomark Prev 17:799–804CrossRefGoogle Scholar
- 26.SEER-Medicare: Summary Table of Available Medicare Data for Cancer & Non-cancer Cases. 2017. Available from: https://healthcaredelivery.cancer.gov/seermedicare/medicare/table.html. Accessed June 1, 2018
- 27.Economic Research Service. Rural-Urban Continuum Codes: United States Department of Agriculture; 2013. Available from: http://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. Accessed June 29, 2018
- 28.NCI Comorbidity Index Overview Bethesda, MD: National Cancer Institute. Available from: https://healthcaredelivery.cancer.gov/seermedicare/considerations/comorbidity.html. Accessed May 4, 2018
- 35.Doubeni CA, Corley DA, Quinn VP, Jensen CD, Zauber AG, Goodman M, Johnson JR, Mehta SJ, Becerra TA, Zhao WK, Schottinger J, Doria-Rose VP, Levin TR, Weiss NS, Fletcher RH (2018) Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study. Gut 67:291–298CrossRefGoogle Scholar