FLEXIBLE SIGMOIDOSCOPY SCREENING FOR COLORECTAL-CANCER IN AVERAGE-RISK SUBJECTS - A COMMUNITY-BASED PILOT PROJECT

Objective: To test a pilot screening program for colorectal cancer. De sign: Subjects, chosen at random and recruited by mail, were examined by flexible sigmoidoscopy. Participants and setting: Normal-risk, asym ptomatic men and women aged 55-59 years recruited from the community, July to December, 1995. Main outcome measures: Number of polyps detect ed and cancers diagnosed, and compliance with screening. Results: Lett ers of invitation were sent to 3500 subjects; of these, 2881 were elig ible for inclusion in the study and 342 (12%) consented to participate . A further 3.5% of non-compliant subjects attended the screening prog ram after a telephone survey assessing reasons for non-attendance. Com mon reasons for non-attendance were a lack of interest (30%) or a lack of time, mainly due to work commitments (28%). A third of subjects ha d polyps and 46% of these were adenomas. Three subjects were found to have adenocarcinoma: in two the cancer was confined to a polyp and tre ated with polypectomy, and one subject underwent anterior resection (o verall prevalence oi cancer, 0.9%). The median depth of insertion achi eved with flexible sigmoidoscopy was 55 cm (range, 25-100 cm). Median pain level (on a scale or 0=no pain to 10=worst pain imaginable) was 2 (range, 0-8.5), and 99% of the subjects would have the test again if required. Conclusions: Flexible sigmoidoscopy was well tolerated and h ad an acceptable detection rate of adenomatous polyps and early cancer . Subject compliance emerged as a major issue which requires further e valuation to maximise participation in future programs.