International Journal of Colorectal Disease

, Volume 21, Issue 2, pp 105–113 | Cite as

History of negative colorectal endoscopy and risk of rectosigmoid neoplasms at screening flexible sigmoidoscopy

  • Luigina Bonelli
  • Stefania Sciallero
  • Carlo Senore
  • Marco Zappa
  • Hugo Aste
  • Bruno Andreoni
  • Donato Angioli
  • Roberto Ferraris
  • Stefano Gasperoni
  • Giuseppe Malfitana
  • Marco Pennazio
  • Wendy Atkin
  • Nereo Segnan
  • SCORE Working Group
Original Article


Background and aims

Screening sigmoidoscopy can reduce incidence of colorectal cancer and mortality. The optimal re-screening interval has not yet been defined. This study is aimed at estimating the risk of distal advanced adenomas (diameter ≥10 mm, villous component >20%, high-grade dysplasia) and cancer at screening flexible sigmoidoscopy in subjects aged 55–64 years who reported pre-screening negative colorectal endoscopy.


Eight thousands two hundred two subjects aged 55–64 years who underwent screening flexible sigmoidoscopy within the SCORE trial in Italy and who were able to report their previous history of colorectal endoscopy.


Eight hundred eighty three of 8,202 subjects (10.8%) reported at least one prescreening negative endoscopy: among them, after 3–5 years, 6–10 years and >10 years intervals between last reported examination and screening endoscopy, the Absolute Risk of advanced adenomas was 1.5%, 0.9% and 0.9%; one cancer was detected (0.1%). Among the 7,319 subjects who did not report prescreening endoscopy the risks of advanced adenoma and cancer were 3.2% and 0.4%, respectively. Subjects with a previous colorectal examination had a 65% decreased risk of advanced adenomas (OR=0.35, 95%CI 0.18–0.66) and a 71% decreased risk of cancer (OR=0.29, 95%CI 0.04–1.12) as compared to those who did not. For subjects without family history of colorectal cancer the statistically significant decrease of the risk persisted up to ten years. The observed benefit seems not to apply to subjects with family history of colorectal cancer.


Our results are consistent with the hypothesis that the interval between screening sigmoidoscopies could be safely expanded beyond 5 years for subjects without specific risk factors for colorectal cancer.



The SCORE trial was supported by grants from the Italian Association for Cancer Research (AIRC 1995–97), the Italian National Research Council (CNR grant no. 95.00539.PF39 and no. 96.00736.PF39) Ministry of Public Health and the Istituto Oncologico Romagnolo (Rimini).

SOFAR s.p.a. provided the enema supply for the patients enrolled in the study.


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Luigina Bonelli
    • 1
    • 14
  • Stefania Sciallero
    • 2
  • Carlo Senore
    • 3
  • Marco Zappa
    • 4
  • Hugo Aste
    • 5
  • Bruno Andreoni
    • 6
  • Donato Angioli
    • 7
  • Roberto Ferraris
    • 8
  • Stefano Gasperoni
    • 9
  • Giuseppe Malfitana
    • 10
  • Marco Pennazio
    • 11
  • Wendy Atkin
    • 12
  • Nereo Segnan
    • 13
  • SCORE Working Group
  1. 1.Secondary Prevention and ScreeningIstituto Nazionale per la Ricerca sul CancroGenoaItaly
  2. 2.Unit of Medical OncologyOspedale San MartinoGenoaItaly
  3. 3.Unit of EpidemiologyCPOPiedmontItaly
  4. 4.Unit of Clinical EpidemiologyCSPOFlorenceItaly
  5. 5.Department of Oncology, Biology and GeneticsUniversità degli StudiGenoaItaly
  6. 6.Unit of Surgery IIstituto Europeo di OncologiaMilanItaly
  7. 7.Unit of GastroenterologyCentro OncologicoArezzoItaly
  8. 8.Unit of GastroenterologyOspedale Mauriziano Umberto ITurinItaly
  9. 9.Unit of GastroenterologyOspedale degli InfermiRiminiItaly
  10. 10.Unit of GastroenterologyOspedale degli InfermiBiellaItaly
  11. 11.Unit of GastroenterologyOspedale San Giovanni ASTurinItaly
  12. 12.Colorectal Cancer UnitImperial Research FundSt MarkItaly
  13. 13.Unit of EpidemiologyCPOPiedmontItaly
  14. 14.GenoaItaly

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