Effect of Flexible Sigmoidoscopy-Based Screening on Incidence and Mortality of Colorectal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

English version České info

Background:
Randomized controlled trials (RCTs) have yielded varying estimates of the benefit of flexible sigmoidoscopy (FS) screening for colorectal cancer (CRC). Our objective was to more precisely estimate the effect of FS-based screening on the incidence and mortality of CRC by performing a meta-analysis of published RCTs.

Methods and Findings:
Medline and Embase databases were searched for eligible articles published between 1966 and 28 May 2012. After screening 3,319 citations and 29 potentially relevant articles, two reviewers identified five RCTs evaluating the effect of FS screening on the incidence and mortality of CRC. The reviewers independently extracted relevant data; discrepancies were resolved by consensus. The quality of included studies was assessed using criteria set out by the Evidence-Based Gastroenterology Steering Group. Random effects meta-analysis was performed.

The five RCTs meeting eligibility criteria were determined to be of high methodologic quality and enrolled 416,159 total subjects. Four European studies compared FS to no screening and one study from the United States compared FS to usual care. By intention to treat analysis, FS-based screening was associated with an 18% relative risk reduction in the incidence of CRC (0.82, 95% CI 0.73–0.91, p<0.001, number needed to screen [NNS] to prevent one case of CRC = 361), a 33% reduction in the incidence of left-sided CRC (RR 0.67, 95% CI 0.59–0.76, p<0.001, NNS = 332), and a 28% reduction in the mortality of CRC (relative risk [RR] 0.72, 95% CI 0.65–0.80, p<0.001, NNS = 850). The efficacy estimate, the amount of benefit for those who actually adhered to the recommended treatment, suggested that FS screening reduced CRC incidence by 32% (p<0.001), and CRC-related mortality by 50% (p<0.001).

Limitations of this meta-analysis include heterogeneity in the design of the included trials, absence of studies from Africa, Asia, or South America, and lack of studies comparing FS with colonoscopy or stool-based testing.

Conclusions:
This meta-analysis of randomized controlled trials demonstrates that FS-based screening significantly reduces the incidence and mortality of colorectal cancer in average-risk patients.

Please see later in the article for the Editors' Summary

Vyšlo v časopise: Effect of Flexible Sigmoidoscopy-Based Screening on Incidence and Mortality of Colorectal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS Med 9(12): e32767. doi:10.1371/journal.pmed.1001352
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001352

Souhrn

Zdroje

1. JemalA, SiegelR, XuJ, WardE (2010) Cancer statistics, 2010. CA Cancer J Clin 60: 277–300.

2. BandiP, CokkinidesV, SmithRA, JemalA (2012) Trends in colorectal cancer screening with home-based fecal occult blood tests in adults ages 50 to 64 years, 2000–2008. Cancer 118: 5092–5099.

3. SeeffLC, RichardsTB, ShapiroJA, NadelMR, ManninenDL, et al. (2004) How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity. Gastroenterology 127: 1670–1677.

4. Screening for colorectal cancer (2008) U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 149: 627–637.

5. LevinB, LiebermanDA, McFarlandB, AndrewsKS, BrooksD, et al. (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 134: 1570–1595.

6. MullerAD, SonnenbergA (1995) Prevention of colorectal cancer by flexible endoscopy and polypectomy. A case-control study of 32,702 veterans. Ann Intern Med 123: 904–910.

7. SelbyJV, FriedmanGD, QuesenberryCPJr, WeissNS (1992) A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. New Engl J Med 326: 653–657.

8. WinawerSJ, ZauberAG, HoMN, O'BrienMJ, GottliebLS, et al. (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. New Engl J Med 329: 1977–1981.

9. AtkinWS, EdwardsR, Kralj-HansI, WooldrageK, HartAR, et al. (2010) Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 375: 1624–1633.

10. HoffG, GrotmolT, SkovlundE, BretthauerM (2009) Risk of colorectal cancer seven years after flexible sigmoidoscopy screening: randomised controlled trial. BMJ 338: b1846.

11. SchoenRE, PinskyPF, WeissfeldJL, YokochiLA, ChurchT, et al. (2012) Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. New Engl J Med 366: 2345–2357.

12. SegnanN, ArmaroliP, BonelliL, RisioM, ScialleroS, et al. (2011) Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian Randomized Controlled Trial–SCORE. J Natl Cancer I 103: 1310–1322.

13. MoherD, LiberatiA, TetzlaffJ, AltmanDG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62: 1006–1012.

14. SchoenfeldP, CookD, HamiltonF, LaineL, MorganD, et al. (1998) An evidence-based approach to gastroenterology therapy. Evidence-Based Gastroenterology Steering Group. Gastroenterology 114: 1318–1325.

15. SussmanJB, HaywardRA (2010) An IV for the RCT: using instrumental variables to adjust for treatment contamination in randomised controlled trials. BMJ 340: c2073.

16. StoopEM, de HaanMC, de WijkersloothTR, BossuytPM, van BallegooijenM, et al. (2012) Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. Lancet Oncol 13: 55–64.

17. JuchemsM, RomppA, KestlerHA, ErnstA, BrambsHJ, et al. (2010) [A prospective comparison of video colonoscopy and CT colonography in asymptomatic patients screened for colorectal cancer]. Deutsche medizinische Wochenschrift 135: 1656–1661.

18. Khalid-de BakkerCA, JonkersDM, SanduleanuS, de BruineAP, MeijerGA, et al. (2011) Test performance of immunologic fecal occult blood testing and sigmoidoscopy compared with primary colonoscopy screening for colorectal advanced adenomas. Cancer Prev Res 4: 1563–1571.

19. ElwoodJM, AliG, SchlupMM, McNoeB, BarbezatGO, et al. (1995) Flexible sigmoidoscopy or colonoscopy for colorectal screening: a randomized trial of performance and acceptability. Cancer Detect Prev 19: 337–347.

20. Parra-BlancoA, Gimeno-GarciaAZ, QuinteroE, NicolasD, MorenoSG, et al. (2010) Diagnostic accuracy of immunochemical versus guaiac faecal occult blood tests for colorectal cancer screening. J Gastroenterol 45: 703–712.

21. ParenteF, MarinoB, DeVecchiN, MorettiR, UcciG, et al. (2009) Faecal occult blood test-based screening programme with high compliance for colonoscopy has a strong clinical impact on colorectal cancer. Br J Surg 96: 533–540.

22. LisiD, HassanC, CrespiM (2010) Participation in colorectal cancer screening with FOBT and colonoscopy: an Italian, multicentre, randomized population study. Dig Liver Dis 42: 371–376.

23. HolL, van LeerdamME, van BallegooijenM, van VuurenAJ, van DekkenH, et al. (2010) Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut 59: 62–68.

24. SegnanN, SenoreC, AndreoniB, AzzoniA, BisantiL, et al. (2007) Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology 132: 2304–2312.

25. FedericiA, MarinacciC, MangiaM, BorgiaP, Giorgi RossiP, et al. (2006) Is the type of test used for mass colorectal cancer screening a determinant of compliance? A cluster-randomized controlled trial comparing fecal occult blood testing with flexible sigmoidoscopy. Cancer Detect Prev 30: 347–353.

26. WeissfeldJL, SchoenRE, PinskyPF, BresalierRS, ChurchT, et al. (2005) Flexible sigmoidoscopy in the PLCO cancer screening trial: results from the baseline screening examination of a randomized trial. J Natl Cancer I 97: 989–997.

27. SegnanN, SenoreC, AndreoniB, ArrigoniA, BisantiL, et al. (2005) Randomized trial of different screening strategies for colorectal cancer: patient response and detection rates. J Natl Cancer I 97: 347–357.

28. MaxwellAE, BastaniR, CrespiCM, DanaoLL, CayetanoRT (2011) Behavioral mediators of colorectal cancer screening in a randomized controlled intervention trial. Prev Med 52: 167–173.

29. BlomJ, YinL, LidenA, DolkA, JeppssonB, et al. (2008) A 9-year follow-up study of participants and nonparticipants in sigmoidoscopy screening: importance of self-selection. Cancer Epidemiol Biomarkers Prev 17: 1163–1168.

30. AdlerA, RollS, MarowskiB, DrosselR, RehsHU, et al. (2007) Appropriateness of colonoscopy in the era of colorectal cancer screening: a prospective, multicenter study in a private-practice setting (Berlin Colonoscopy Project 1, BECOP 1). Dis Colon Rectum 50: 1628–1638.

31. BleibergH, AutierP, HuetF, SchrauwenAM, StaquetE, et al. (2006) Colorectal cancer (CRC) screening using sigmoidoscopy followed by colonoscopy: a feasibility and efficacy study on a cancer institute based population. Ann Oncol 17: 1328–1332.

32. PabbyA, SunejaA, HeerenT, FarrayeFA (2005) Flexible sigmoidoscopy for colorectal cancer screening in the elderly. Digest Dis Sci 50: 2147–2152.

33. MorikawaT, KatoJ, YamajiY, WadaR, MitsushimaT, et al. (2005) A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology 129: 422–428.

34. CanardJM, Debette-GratienM, DumasR, EscourrouJ, GayG, et al. (2005) A prospective national study on colonoscopy and sigmoidoscopy in 2000 in France. Gastroenterologie clinique et biologique 29: 17–22.

35. NewcombPA, StorerBE, MorimotoLM, TempletonA, PotterJD (2003) Long-term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidence. J Natl Cancer I 95: 622–625.

36. VerneJE, AubreyR, LoveSB, TalbotIC, NorthoverJM (1998) Population based randomized study of uptake and yield of screening by flexible sigmoidoscopy compared with screening by faecal occult blood testing. BMJ 317: 182–185.

37. LiebermanDA, WeissDG, BondJH, AhnenDJ, GarewalH, et al. (2000) Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. New Engl J Med 343: 162–168.

38. SchoenRE, CorleD, CranstonL, WeissfeldJL, LanceP, et al. (1998) Is colonoscopy needed for the nonadvanced adenoma found on sigmoidoscopy? The Polyp Prevention Trial. Gastroenterology 115: 533–541.

39. AdlerM, DemolsA, FranchimontD, Van LaethemJL, Van GossumA (2001) [Screening for colorectal cancer by endoscopy: rectosigmoidoscopy or coloscopy?]. Revue medicale de Bruxelles 22: A210–213.

40. Thiis-EvensenE, HoffGS, SauarJ, LangmarkF, MajakBM, et al. (1999) Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I Scand J Gastroentero 34: 414–420.

41. KronborgO, FengerC, OlsenJ, JorgensenOD, SondergaardO (1996) Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 348: 1467–1471.

42. LindholmE, BrevingeH, HaglindE (2008) Survival benefit in a randomized clinical trial of faecal occult blood screening for colorectal cancer. Br J Surg 95: 1029–1036.

43. MandelJS, BondJH, ChurchTR, SnoverDC, BradleyGM, et al. (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. New Engl J Med 328: 1365–1371.

44. BaxterNN, GoldwasserMA, PaszatLF, SaskinR, UrbachDR, et al. (2009) Association of colonoscopy and death from colorectal cancer. Ann Intern Med 150: 1–8.

45. BrennerH, HoffmeisterM, ArndtV, StegmaierC, AltenhofenL, et al. (2010) Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer I 102: 89–95.

46. SinghH, NugentZ, MahmudSM, DemersAA, BernsteinCN (2010) Predictors of colorectal cancer after negative colonoscopy: a population-based study. Am J Gastroenterol 105: 663–673; quiz 674.

47. Thiis-EvensenE, KaminskiMF, BretthauerM (2011) First randomized trial of colonoscopy screening for the prevention of colorectal cancer. Gastrointest Endosc 73: AB159.

48. KaminskiMF, BretthauerM, ZauberAG, KuipersEJ, AdamiHO, et al. (2012) The NordICC Study: rationale and design of a randomized trial on colonoscopy screening for colorectal cancer. Endoscopy 44: 695–702.

49. QuinteroE, CastellsA, BujandaL, CubiellaJ, SalasD, et al. (2012) Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. New Engl J Med 366: 697–706.

50. Colonoscopy versus fecal immunochemical test in reducing mortality from colorectal cancer (CONFIRM). ClinicalTrials.gov Identifier: NCT01239082

51. ElmunzerBJ, O'ConnellMT, PrendesS, SainiSD, SussmanDA, et al. (2011) Improving access to colorectal cancer screening through medical philanthropy: feasibility of a flexible sigmoidoscopy health fair for uninsured patients. Am J Gastroenterol 106: 1741–1746.