Colorectal-Cancer Incidence and Mortality with Screening Flexible Sigmoidoscopy

被引：812

作者：

Schoen, Robert E. ^{[1
,2
,3
]}

Pinsky, Paul F. ^{[4
]}

Weissfeld, Joel L. ^{[2
,3
]}

Yokochi, Lance A. ^{[9
]}

Church, Timothy ^{[10
]}

Laiyemo, Adeyinka O. ^{[11
]}

Bresalier, Robert ^{[13
]}

Andriole, Gerald L. ^{[14
]}

Buys, Saundra S. ^{[15
]}

Crawford, E. David ^{[16
]}

Fouad, Mona N. ^{[17
]}

Isaacs, Claudine ^{[12
]}

Johnson, Christine C. ^{[18
]}

Reding, Douglas J. ^{[19
]}

O'Brien, Barbara ^{[7
]}

Carrick, Danielle M. ^{[7
]}

Wright, Patrick ^{[8
]}

Riley, Thomas L. ^{[8
]}

Purdue, Mark P. ^{[5
]}

Izmirlian, Grant ^{[4
]}

Kramer, Barnett S. ^{[4
]}

Miller, Anthony B. ^{[20
]}

Gohagan, John K. ^{[6
]}

Prorok, Philip C. ^{[4
]}

Berg, Christine D. ^{[4
]}

机构：

[1] Univ Pittsburgh, Dept Med, Pittsburgh, PA 15260 USA

[2] Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15261 USA

[3] Univ Pittsburgh, Inst Canc, Pittsburgh, PA USA

[4] NCI, Canc Prevent Div, Bethesda, MD 20892 USA

[5] NCI, Div Canc Epidemiol & Genet, Bethesda, MD 20892 USA

[6] NIH, Off Dis Prevent, Bethesda, MD 20892 USA

[7] Westat Corp, Rockville, MD USA

[8] Informat Management Serv Inc, Rockville, MD USA

[9] Pacific Hlth Res & Educ Inst, Rockville, MD USA

[10] Univ Minnesota, Dept Hlth Studies & Environm Hlth Sci, Minneapolis, MN USA

[11] Howard Univ, Dept Med, Washington, DC 20059 USA

[12] Georgetown Univ, Washington, DC USA

[13] Univ Texas Houston, MD Anderson Canc Ctr, Houston, TX 77030 USA

[14] Washington Univ, St Louis, MO 63130 USA

[15] Univ Utah, Huntsman Canc Inst, Salt Lake City, UT USA

[16] Univ Colorado, Anschutz Canc Pavil, Denver, CO 80202 USA

[17] Univ Alabama Birmingham, Sch Med, Birmingham, AL USA

[18] Henry Ford Hlth Syst, Detroit, MI USA

[19] Marshfield Clin Res Fdn, Marshfield, WI USA

[20] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2012年 / 366卷 / 25期

关键词：

RANDOMIZED CONTROLLED-TRIAL; OCCULT BLOOD-TEST; SURVEILLANCE COLONOSCOPY; NEGATIVE COLONOSCOPY; PROSTATE; LUNG; ASSOCIATION; DEATH; YIELD; RISK;

D O I：

10.1056/NEJMoa1114635

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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.)

引用

页码：2345 / 2357

页数：13

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