M. Rasmussen et al., Possible advantages and drawbacks of adding flexible sigmoidoscopy to Hemoccult-II in screening for colorectal cancer - A randomized study, SC J GASTR, 34(1), 1999, pp. 73-78
Background: Flexible sigmoidoscopy (FS) has been recommended as a screening
method to reduce mortality from colorectal cancer (CRC). The present study
evaluates the effect of adding FS to the fecal occult blood test Hemoccult
-II (H-II) on diagnostic yield of colorectal neoplasia. Methods: A total of
10,978 normal persons aged 50-75 years were invited to participate, 5495 p
ersons being allocated at random to H-II and FS and 5483 to H-II alone. Res
ults: In spite of a lower compliance (40 % versus 56 %) for the combined pr
ocedure, the diagnostic yield of colorectal neoplasia was higher than for H
-II alone (12 CRC versus 4 CRC, and 72 large adenomas versus 14). Within 24
-62 months after screening there were fewer CRCs detected after H-II + FS t
han after H-II alone. The stage distribution was less favorable than in scr
een-detected cases. Conclusion: One FS may not be an optimal way of screeni
ng, but FS deserves to be evaluated in randomized population studies includ
ing repeated H-II tests in the control arm.