Abstract
Objective:To determine the strength of the evidence in the literature that screening proctosigmoidoscopy reduces colorectal cancer mortality.
Design:All English-language studies reporting mortality or survival from screening proctosigmoidoscopy published since 1960 were critically reviewed.
Data extraction:Fifteen references reported on five studies of screening proctosigmoidoscopy. Two authors independently reviewed each reference using explicit methodologic criteria, particularly for potential sources of bias.
Measurements and main results:Of the five studies, four used historical controls and were susceptible to bias, especially self-selection and lead-time bias. Only the Kaiser-Permanente Multiphasic Health Check-up study collected a representative patient sample from a defined population, had randomly allocated controls, and avoided multiple sources of bias. There was a reduction in mortality from a group of seven potentially postponable causes of mortality, including colorectal cancer, although no difference in overall mortality between screened and control groups was found. This study was not designed to determine specifically the impact of screening proctosigmoidoscopy on mortality from colorectal cancer, and suggested that most of the reduction in colorectal cancer deaths was due to a lower incidence in the screened group, which could not be attributed to polypectomy. The benefit of screening proctosigmoidoscopy in this study, if any, was small.
Conclusions:The evidence in the literature is inadequate to determine whether or not screening proctosigmoidoscopy has an impact on colorectal cancer mortality, but the best available data suggest that the benefit is small, at best.
Similar content being viewed by others
References
American Cancer Society. ACS report on the cancer-related health checkup. CA. 1980; 30:208–15.
Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J. 1979; 121:1193–254.
Breslow L, Somers AR. The lifetime health-monitoring program: a practical approach to preventive medicine. N Engl J Med. 1977; 296:601–8.
Frame PS, Carlson SJ. A critical review of periodic health screening using specific screening criteria. Part 2: selected endocrine, metabolic and gastrointestinal diseases. J Fam Pract. 1975; 2:123–9.
Braunwald E, Isselbacher KJ, Petersdorf RG, Wilson JD, Fauci AS, eds. Harrison’s principles of internal medicine. 11th ed. New York: McGraw-Hill, 1982; 1298–301.
Wyngaarden JB, Smith LH, eds. Cecil textbook of medicine. 17th ed. Philadelphia: W. B. Saunders, 1985;764–71.
Holland JF, Frei E, eds. Cancer medicine. 2nd ed. Philadelphia: Lea and Febiger, 1982; 350–3, 2257.
DeVita VT, Hellman S, Rosenberg SA, eds. Cancer: principles and practice of oncology. 2nd ed. Philadelphia: J. B. Lippincott, 1985; 827–31.
Sabiston DC, ed. Textbook of surgery: the biological basis of modern surgical practice. 13th ed. Philadelphia: W. B. Saunders, 1986;1004–9.
Sleisenger MH, Fordtran JS, eds. Gastrointestinal disease. 3rd ed. Philadelphia: W. B. Saunders, 1983; 1228–31.
Berk JE, Haubrich WS, Kalser MH, Roth JLA, Schaffner F, eds. Bockus gastroenterology. 4th ed. Philadelphia: W. B. Saunders, 1985; 2552–4.
Chuong JJ. A screening primer: basic principles, criteria, and pitfalls of screening with comments on colorectal carcinoma. J Clin Gastroenterol. 1983; 5:229–33.
Diehl AK. Screening for colorectal cancer. J Fam Pract. 1981; 12:625–32.
Shahon DB, Wangensteen OH. Early diagnosis of cancer of the gastrointestinal tract. Postgrad Med. 1960; 27:306–11.
Gilbertsen VA, Wangensteen OH. The results of efforts for asymptomatic diagnosis of malignant disease. Surg Gynecol Obstet. 1963; 116:413–6.
Gilbertsen VA, Knatterud GL, Lober PH, Wangensteen OH. Invasive carcinoma of the large intestine: a preventable disease? Surgery. 1965; 57:363–5.
Gilbertsen VA. Proctosigmoidoscopy and polypectomy in reducing the incidence of rectal cancer. Cancer. 1974; 34:936–9.
Gilbertsen VA, Nelms JM. The prevention of invasive cancer of the rectum. Cancer. 1978; 41:1137–9.
Gilbertsen VA. Colon cancer screening: the Minnesota experience. Gastrointest Endosc. 1980; 26:31S-32S.
Hertz RE, Deddish MR, Day E. Value of periodic examinations in detecting cancer of the rectum and colon. Postgrad Med 1960; 27:290–4.
Crumpacker EL, Baker JP. Proctosigmoidoscopy in periodic health examinations. JAMA. 1961; 178:1033–5.
Lynch HT, Harlan W, Swartz M, et al. Multiphasic mobile cancer screening: a positive approach to early cancer detection and control. Cancer. 1972; 30:774–81.
Lynch H, Lynch J, Kraft C. A new approach to cancer screening and education. Geriatrics. 1973; 28:152–7.
Lynch HT, Brodkey FD, Guirgis HA, Swartz MJ, Lynch JF, Lynch PM. Survival data from a multiphasic mobile cancer detection unit. Oncology. 1976; 33:179–82.
Dales LG, Friedman GD, Ramcharan S, et al. Multiphasic checkup evaluation study. Prev Med. 1973; 2:221–35.
Dales LG, Friedman GD, Collen MF, Evaluating periodic multiphasic health checkups: a controlled trial. J Chronic Dis. 1979; 32:385–404.
Friedman GD, Collen MF, Fireman BH. Multiphasic health checkup evaluation: a 16-year followup. J Chronic Dis. 1986; 39:453–63.
Selby JV, Friedman GD, Collen MF. Sigmoidoscopy and mortality from colorectal cancer: the Kaiser Permanente multiphasic evaluation study. J Clin Epidemiol. 1988; 41:427–34.
Cole P, Morrison AS. Basic issues in population screening for cancer. J Natl Cancer Inst. 1980; 1263–72.
Morrison AS. Sequential pathogenic components of rates. Am J Epidemiol. 1979; 109:709–18.
Sackett DL. Screening for early detection of disease: to what purpose? Bull NY Acad Med. 1975; 51: 39–52.
Hutchison GB, Shapiro S. Lead time gained by diagnostic screening for breast cancer. J Natl Cancer Inst. 1968; 41:665–81.
Shapiro S. Evidence on screening for breast cancer from a randomized trial. Cancer. 1977; 39:2772–82.
Fletcher SW, Dauphinee WD. Should colorectal carcinoma be sought in periodic health examinations? An approach to the evidence. Clin Invest Med. 1981; 4:23–31.
Neugut AI, Pita S. Role of sigmoidoscopy in screening for colorectal cancer: a critical review. Gastroenterology. 1988; 95:492–9.
Author information
Authors and Affiliations
Additional information
Received from the General Internal Medicine Service, Department of Medicine, Fitzsimons Army Medical Center, Aurora, Colorado.
This article was previously presented and published in abstract form (Clin Res 1987; 35:754A).
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.
Rights and permissions
About this article
Cite this article
Ow, C.L., Lemar, H.J. & Weaver, M.J. Does screening proctosigmoidoscopy result in reduced mortality from colorectal cancer?. J Gen Intern Med 4, 209–215 (1989). https://doi.org/10.1007/BF02599525
Issue Date:
DOI: https://doi.org/10.1007/BF02599525