Once-only flexible sigmoidoscopy screening, with or without fecal occult blood testing (FOBT), is associated with reduced colorectal cancer incidence and mortality, according to a study published in the Journal of the American Medical Association.

Øyvind Holme, M.D., from the Sorlandet Hospital Kristiansand in Norway, and colleagues conducted a randomized trial involving 98,792 individuals, aged 50 to 64 years, to examine the effectiveness of flexible sigmoidoscopy screening.

Participants who were randomized to screening underwent once-only flexible sigmoidoscopy (10,283 individuals) or combination of once-only flexible sigmoidoscopy and FOBT (10,289 individuals), while the control group received no intervention (78,220 individuals).


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After a median of 10.9 years, the researchers found that there were 71 colorectal cancer deaths in the screening group compared with 330 in the control group (31.4 versus 43.1 per 100,000 person-years; absolute rate difference, 11.7; hazard ratio, 0.73).

There were 253 diagnoses of colorectal cancer in the screening group versus 1,086 in the control group (112.6 versus 141.0 cases per 100,000 person-years; absolute rate difference, 28.4; hazard ratio, 0.80). The incidence of colorectal cancer was reduced among those aged 50 to 54 years (hazard ratio, 0.68) and among those aged 55 to 64 years (hazard ratio, 0.83). There was no significant difference between the screening groups.

“In Norway, once-only flexible sigmoidoscopy screening or flexible sigmoidoscopy and FOBT reduced colorectal cancer incidence and mortality on a population level compared with no screening,” the authors write.

One author disclosed financial ties to the medical device and health care industries.

  1. Holme, Øyvind, MD, et al. “Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality: A Randomized Clinical Trial.” JAMA. doi:10.1001/jama.2014.8266. August 13, 2014.