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N Engl J Med. 2012 Jun 21;366(25):2345-57. doi: 10.1056/NEJMoa1114635. Epub 2012 May 21.

Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy.

Collaborators (791)

Berg CD, Gohagan JK, Prorok PC, Hsing AW, Lacey JV Jr, Purdue M, Hayes RB, Black A, Huang WY, Simpson NK, Cumberlin R, Rossi S, Yu K, Zhu C, Marquez G, Browne JE, Hoffman S, Baca D, Coleman DM, Jackson C, Lange E, Loesch M, McMillan D, Papadopoulos E, Sylver-Foust D, Weiszer R, Sullivan D, Brown M, Gaegler J, Gray L, Hansborough A, Greenwald P, Fraumeni JF, Fagerstrom RM, Hu P, Izmirlian G, Levin DL, Pinsky P, Xu JL, Kreimer A, Marcus PM, Subar AF, Greenwald P, Kramer BS, Hartge P, Hoover RN, Ziegler RG, Costlow R, Laine AF, Miller AB, Pearson D, van Nagell JR, Stallings FL, Miller DS, Chia D, Dry S, Seligson D, Terasaki P, Reiss J, Tze S, Acalinovich A, Besada S, Chan H, Cheung-Lau G, Corbett S, Durongwong P, Eeva M, Folayan L, Gruebel B, Habeeb O, Huynh K, Kanegai C, Kim H, Kim S, Ko A, Kohlmeier S, Lamb C, Lu M, Martin J, Maynard S, Noravian F, Schirrippa O, Padilla G, Rumbin A, Shevlin L, Ty R, Wang Q, Wong J, Xu S, Yu H, Koci J, Kopp W, Rager H, Smith C, Roser D, Cahill J, O'Brien B, Gardner S, Carrick D, Yurgalevitch S, Dunn M, Bailey C, Bodenstein Y, Burr P, Cutrin J, Eisen J, Frias A, Glashofer S, Hurt-Mullen K, Kavounis K, Ke P, Khanani F, Laimon B, Mechanic L, Mesnard M, Nichaman L, Novey S, Palace C, Peace S, Pettit K, Pratt S, Ragard L, Rosenbaum J, Sanchez D, Schuman S, Stewart M, Waterman MB, Umbel K, Ferrantello D, Havel B, Hasson MA, Bridgeman B, Martinusen E, Sabastianelli M, Miller A, Menacker F, Miedzinski M, Chowdry S, Miesko L, Lease C, Rinehart M, Agamir M, Awatramani K, Barbee J, Barlow WC, Beach D, Bradley B, Brenner K, Butler L, Bristor J, Caughman C, Chanapatna R, Cranson L, Desir J, Donegan K, Fleming J, Florczyk M, Galyon J, Gordon C, Han C, Hendricks A, Hickman D, Ho M, Jackson E, Kahane DC, Khan A, Laio M, Lee A, Lott B, Lucas-Mudd D, Moore D, Morgan A, Neagu G, Ohan P, Revzin M, Rychlec J, Samiel R, Siford E, Simons D, Smith M, Swei L, Theodorou E, Vakhlis A, Walsh JH, Wenzel B, Whitlock M, Williamson S, Wu M, Yang CL, Yoda S, Wu M, Myers MH, Young PA, Lewis DA, Francis RW Jr, Saunders LA, Signes C, Scheck S, Lake W Jr, Riley T, Austin J, Erwin DE, Flynn D, Mabie JE, Clapp JD, Moore MR, Xu F, Jones GC, Rathmell JM, Williams CR, Young M, Goodman A, Hickey TP, Commins JM, Wright P, Shaul SK, Crawford E, Ogden SL, Tenorio S, Fyles P, Golz D, Hommel S, McCormick D, Pashleigh G, Slimak N, Turner N, Ayodeji NG, Josse D, McAfee J, Meskimen E, Pennington J, Suchey W, Ali-Ahmadi M, Barnett AW, Brothers J, Chronister ND, Cipolla D, Crawford R, Chun S, Gebhart K, Hernandez J, Hunter H, Patel K, Poage W, Pozzetta M, Simms S, Swingler J, Taylor C, Turner M, Wallack A, Curtis K, Pierce D, Borrego PV, Rundus C, Bonde E, Gamito E, Pretzel S, Dahmer J, Deines T, Geske M, Holladay M, Jackson H, Jordan T, Ordonez E, Beechum T, Crawford M, Dittmer K, Donohue A, Garcia F, Giese S, Klenfield A, Kleinman M, Moss W, Motomiya K, Murken R, Neel D, Quintela J, Razook C, Shoaga A, Thompson A, Vargas S, Lynch D, O'Driscoll M, Townsend R, Stamm E, Drose J, Davidson S, Ahnen D, Levine J, Murchison W, Steinberg S, Gelmann EP, Isaacs C, McGuire C, Trocky N, Bourdeau C, Ke P, Martino L, Apostolides I, Elbon-Copp C, Klemm K, Lippman C, Klotz C, McLaurin T, Williams T, Ginyard J, Cantrell S, Marsh G, Tran A, Wray C, Yondonsambu B, Taddeo C, Bennett K, Bowen T, English K, Seaton K, Hammond T, Ford M, Newman K, Kren M, English N, McKenzie D, Yokochi LA, Gilbert F, Curb D, Davis J, Kessel B, Navin J, Petrovich H, Shambaugh V, Tabrah F, Waitzfelder B, Willcox B, Jenkins V, Chasnoff R, Vander Does J, Martin J, Ideta B, Stryker K, Batangan E, Dolan L, Horton K, Taylor K, Tokumine T, Troyer R, Barrow S, Hayashida S, Commander S, Turner L, Hino G, Nakano E, Johnson M, Villaruz L, Chung A, Huynh W, Hickey N, Calulot M, Chun V, Lewis C, Morfit J, Tani J, Banggo K, Brunst A, Francis W, Grove L, Holderbaum B, Kinney K, Ogino M, O'Sullivan T, Rowan-Lau P, Bow K, Shiratori H, Tsukamoto J, Hodges H, Hyun S, Kuiee J, Lucente L, Oshiro P, Shota K, Kvale PA, Demers R, Fogel R, Rutt W, Johnson CC, Lamerato L, Bresalier RS, Broski K, Hensley-Alford S, Ford ME, LaFata JE, McCarthy B, Ward R, Andrews T, Day M, Flickinger LM, Hantz T, Talley D, Wilson D, Blount A, Tammemagi C, Goswami N, Haykus W, Piasecki A, Barr C, Hall T, Stanifer S, Baker P, Montague R, Day C, Nanovski A, Hill C, Boles T, Witherspoon A, Banks G, Green K, Bernardin K, Kozlowski P, Wells J, Salisbury H, Shepard A, McKeeman J, Jeffery T, Castor C, Boswell M, Hooker C, Ingram L, Mototolea D, Szabo N, Gardner M, Hooker C, Maddy N, Morris J, Berlicz J, Bonds T, Fountain S, Williams M, Djuric B, Gardner M, Cross C, Emmer D, Jagger F, Johnson A, McCarver L, Scharbonneau M, Thomas V, Norwood M, Mobley M, Kokko S, Doute D, Ciccoretti K, Wright KW, Shabazz P, Leyson-Fiel A, Pratt K, Bailey M, Alexander T, Kok JL, Church TR, Mandel J, Oken MM, Engelhard D, Cordes J, Bradley P, Hansen C, Kokubu J, Lee R, Meyer G, McLaughlin H, Palmquist K, Sandley N, Sigal B, Barnes T, Fleishhacker M, Grengs J, Hebner S, Lewis M, Mendez A, Miller D, Nielsen J, Theis L, Bangerter A, DesMarais D, Portnov N, Silverman G, Strahan F, Vuong S, Watt G, Zirbes A, Fredrickson A, Hoffbeck R, Murzyn R, Woodside J, Beckmann P, Boldt M, Jurjans L, Swenson S, Terrien S, Fisher J, Geisser M, Mongin S, Oancea C, Jansen R, Breer S, Collins S, Manuel J, Matous L, Miller L, Muller C, Olsson P, Peterson S, Steele ML, Tonnell S, Halverson J, Hanna M, Hathaway-Ott J, Harper B, Hunter H, Lindall-Hawkins J, Longen C, Nickelson S, Overby D, Rodier M, Smith B, Weiner V, Clement M, Haselhuhn C, Heath D, Julin E, Michels N, Naslund L, Pagidipala S, Swavely D, Syktta C, Warren D, Sitarz J, Steinberg C, Thomas J, Burrell J, Sandell L, Helevik S, Hoard M, Andriole GL, Lowery AA, Freesmeier E, Charlton E, Desai A, Gardner V, Stanczak D, Taylor K, Civitelli K, Ehrhard K, Nieters P, Hilke C, Phillips K, Robinson W, Wehde M, Branam C, Freesmeier K, Kane C, Murphey S, Royal D, Scire J, Bickford K, Fleming E, Goforth J, Graham D, Montani J, Naughton K, Palumbo B, Sicard-Su J, Blanke R, Cashel P, DeFord K, Liddy K, Lieberoff A, Nelson K, Reismeyer L, Ritter B, Robertson S, Standbrook S, Stilts D, Webb J, Carrett K, Laster S, Stolin C, Weissfeld JL, Schoen RE, Hill L, Hakala T, Guido R, Fuhrman C, Overly W, Proctor JW, Sulecki M, Trombetta M, Gahagan B, Bonk J, Yagjian M, Gitchel R, Sufka P, McDonough K, Carl K, Gongloff J, Karl T, Lucas C, Lytle L, Sibbet M, Weinstein J, Coopie B, Dyjak L, Johnson L, Kielty J, Landis G, Misko S, Oleson P, Ritman M, Clement L, Danvers A, Riley MA, Buys SS, Gren LH, Childs J, Andersen A, Bacon J, Bossi M, Briscoe L, Broschinsky M, Callahan B, Conner T, Ernst J, Fischer R, Gregersen J, Hamatake N, Hamatake C, Henrichsen A, Ihler N, Jensen L, Jones K, Killian L, Liddle M, Lochner M, Monaco A, Morreal R, Nate A, Nolan K, Olson C, Park A, Ricks S, Sheltra S, Stewart A, Sturges L, Sullenger J, Taylor K, Toyn C, Van Stam E, Argyle N, Christensen J, Bennett S, Biggs J, Branson D, Bryson M, Childs B, Dalton C, Doi B, Doi J, Foss S, Gudgell P, Hicks L, Hsu P, LaMay D, Montalbo C, Newman L, Randall A, Thompson J, Schliep K, Stanfield K, Watson D, Newman L, Reese M, Whittaker B, Whittaker N, Wicklander E, Wolf J, Varner J, Bennett N, Bonoacci M, Harper A, Reay S, McFadden K, O'Toole K, Butcher T, Walker D, Richardson J, Hong H, Lund B, Rowley J, Tlachac J, VanRy J, Walker C, Hamilton B, Labasky R, Landau S, Middleton R, Stephenson R, Beck TM, Sturges L, Wohlers B, Berreth K, Roberts P, Carter P, Goodman D, Hagerman G, Hon T, Marshock J, Martin R, Jamieson C, Arnone A, Davis D, Dennis K, Hanson D, Hyder J, McCraney D, Michel K, Shahriari F, Sirianni L, Burt TB, Carrasco CR, Daniel EN, Lane RH, Langhus PA, Leymaster CE, Maxwell JR, Thorpe RM, Nelson BD, Marx SV, Hubler B, Waltz JS, DeMordaunt QA, Fisher MT, Battershall P, Burke L, Fortunati L, Werdel JM, Reding D, Greenlee R, Hocking W, Lappe K, Multerer D, Fischer V, Heiting JC, Mueller C, Mathiesen-Viergutz K, Bohman K, Carey L, Vieth A, Aue K, Kriescher D, Miller C, Thums N, Wein S, Kofka K, Luttropp K, Mueller C, Dix B, Mueller L, Swensen K, Wachholz S, Kramer R, Bright B, Zahradka S, Fouad M, Oberman A, Partridge E, Urban D, Kiefe C, Shikany J, Higgins D, Thompson J, Johnson M, Moore A, Powell B, McCoy B, Oden C, Khatri R, Pike M, Rafla S, Angelone A, DeStefano V, Varkey J, Watson S, DiVernieri JM.

Author information

  • 1Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. rschoen@pitt.edu

Abstract

BACKGROUND:

The benefits of endoscopic testing for colorectal-cancer screening are uncertain. We evaluated the effect of screening with flexible sigmoidoscopy on colorectal-cancer incidence and mortality.

METHODS:

From 1993 through 2001, we randomly assigned 154,900 men and women 55 to 74 years of age either to screening with flexible sigmoidoscopy, with a repeat screening at 3 or 5 years, or to usual care. Cases of colorectal cancer and deaths from the disease were ascertained.

RESULTS:

Of the 77,445 participants randomly assigned to screening (intervention group), 83.5% underwent baseline flexible sigmoidoscopy and 54.0% were screened at 3 or 5 years. The incidence of colorectal cancer after a median follow-up of 11.9 years was 11.9 cases per 10,000 person-years in the intervention group (1012 cases), as compared with 15.2 cases per 10,000 person-years in the usual-care group (1287 cases), which represents a 21% reduction (relative risk, 0.79; 95% confidence interval [CI], 0.72 to 0.85; P<0.001). Significant reductions were observed in the incidence of both distal colorectal cancer (479 cases in the intervention group vs. 669 cases in the usual-care group; relative risk, 0.71; 95% CI, 0.64 to 0.80; P<0.001) and proximal colorectal cancer (512 cases vs. 595 cases; relative risk, 0.86; 95% CI, 0.76 to 0.97; P=0.01). There were 2.9 deaths from colorectal cancer per 10,000 person-years in the intervention group (252 deaths), as compared with 3.9 per 10,000 person-years in the usual-care group (341 deaths), which represents a 26% reduction (relative risk, 0.74; 95% CI, 0.63 to 0.87; P<0.001). Mortality from distal colorectal cancer was reduced by 50% (87 deaths in the intervention group vs. 175 in the usual-care group; relative risk, 0.50; 95% CI, 0.38 to 0.64; P<0.001); mortality from proximal colorectal cancer was unaffected (143 and 147 deaths, respectively; relative risk, 0.97; 95% CI, 0.77 to 1.22; P=0.81).

CONCLUSIONS:

Screening with flexible sigmoidoscopy was associated with a significant decrease in colorectal-cancer incidence (in both the distal and proximal colon) and mortality (distal colon only). (Funded by the National Cancer Institute; PLCO ClinicalTrials.gov number, NCT00002540.).

Comment in

PMID:
22612596
[PubMed - indexed for MEDLINE]
PMCID:
PMC3641846
Free PMC Article

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