Colorectal cancer screening: Video-reviewed flexible sigmoidoscopy by nurse endoscopists - A Canadian community-based perspective

BACKGROUND: Colorectal cancer (CRC) is the third most common incident cance r and the second most fatal cancer in Canada. Flexible sigmoidoscopy (FS) i s one of the modalities under consideration for CRC screening. The present series reports on a screening program of FS performed by nonphysician endos copists in a Canadian community setting, with video review of procedures by physicians and recommendation of follow-up colonoscopy where polyps are id entified. RESULTS: Five hundred twenty-five, average risk, asymptomatic patients were examined. After exclusion of inappropriate referrals, 488 remained for ana lysis. The duration and extent of examination were comparable with those of previous studies elsewhere. Compliance with suggested follow-up was 97.3%. Polyps were identified at FS in 15.4% of examinees. In 8.2% of patients, t he polyps were neoplastic at subsequent histology. Four malignant lesions w ere detected, all at an early stage. There were no complications of FS. INTERPRETATION: This report shows chat FS can be carried out safely and eff ectively by nonphysician personnel in a community setting in Canada. The ma npower cost for nonphysician operators is considerably less than that for s pecialist physician endoscopists. This approach deserves consideration in c ost effectiveness analyses of CRC screening.