International Journal of Colorectal Disease

, Volume 34, Issue 7, pp 1273–1281 | Cite as

Screening flexible sigmoidoscopy versus colonoscopy for reduction of colorectal cancer mortality

  • Cynthia W. KoEmail author
  • V. Paul Doria-Rose
  • Michael J. Barrett
  • Aruna Kamineni
  • Lindsey Enewold
  • Noel S. Weiss
Original Article



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.


Colorectal neoplasm Mass screening Colonoscopy Sigmoidoscopy Case-control studies 


Supplementary material

384_2019_3300_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14.6 kb)
384_2019_3300_MOESM2_ESM.docx (159 kb)
ESM 2 (DOCX 158 kb)


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Copyright information

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.Department of MedicineUniversity of Washington School of MedicineSeattleUSA
  2. 2.Division of GastroenterologyUniversity of WashingtonSeattleUSA
  3. 3.National Cancer Institute, National Institutes of HealthBethesdaUSA
  4. 4.Information Management Services, Inc.CalvertonUSA
  5. 5.Kaiser Permanente Washington Health Research InstituteSeattleUSA
  6. 6.Department of EpidemiologyUniversity of WashingtonSeattleUSA

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