Abstract
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.
Patients
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.
Results
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.
Conclusions
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.
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Acknowledgements
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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Members of the SCORE Working Group are provided in Appendix A
The SCORE Working Group-Italy
The SCORE Working Group-Italy
Arezzo | |
Ghezzi P | Centro Oncologico |
Sforza V | Unit of Pathology, Centro Oncologico |
Agnolucci A | Unit of Gastroenterology, Ospedale S Donato |
Ceccatelli P | Unit of Gastroenterology, Ospedale S Donato |
Biella | |
Penna A | Fondo “ E Tempia”–ASL 12 |
Azzoni A | Unit of Gastroenterology, Ospedale degli Infermi–ASL 12 |
Ferrero F | Unit of Gastroenterology, Ospedale degli Infermi–ASL 12 |
Giudici M | Unit of Pathology, Ospedale degli Infermi–ASL 12 |
Genoa | |
Munizzi F | Unit of Gastroenterology and Nutrition, National Institute for Cancer Research |
Saccomanno S | Unit of Gastroenterology and Nutrition, National Institute for Cancer Research |
Pugliese V | Unit of Gastroenterology and Nutrition, National Institute for Cancer Research and Department of Oncology Biology and Genetics–University of Genova |
Nicora AM | Unit of Clinical Epidemiology, National Institute for Cancer Research |
Milano | |
Bargiggia S | Endoscopy Unit, Sacco Hospital, Milan |
Gerosa C | Unit of Gastroenterology, S Carlo Hospital, Milan |
Minoli G | Unit of Gastroenterology, Valduce Hospital, Como |
Penagini R | Endoscopy Unit, Policlinico Hospital, Milan |
Prada A | Unit of Gastroenterology, General Hospital, Rho |
Viale E | Endoscopy Unit, S Raffaele Hospital, Milan |
Crosta C | Unit of Gastroenterology, European Institute of Oncology |
Fiori G | Unit of Gastroenterology, European Institute of Oncology |
Bosari S | Unit of Pathology, European Institute of Oncology |
Viale G | Unit of Pathology, European Institute of Oncology |
Marzona L | Surgery II, European Institute of Oncology and University of Milano |
Lotti M | Surgery II, European Institute of Oncology and University of Milano |
Rimini | |
Giuliani O | Unit of Gastroenterology, Infermi Hospital |
Cardelli A | Unit of Gastroenterology, Infermi Hospital |
Rinaldi P | Pathology Unit, Infermi Hospital |
Turin | |
Arrigoni A | Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1 |
Bertone A | Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1 |
Cavallero M | Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1 |
Gemme C | Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1 |
Spandre M | Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1 |
Rossini FP | Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1 |
Berardengo E | Unit of Pathology, Ospedale S Giovanni Antica Sede, ASL 1 |
Coppola F | Unit of Gastroenterology, Ospedale Mauriziano “Umberto I” |
Fracchia M | Unit of Gastroenterology, Ospedale Mauriziano “Umberto I” |
Galatola G | Unit of Gastroenterology, Ospedale Mauriziano “Umberto I” |
Pera A | Unit of Gastroenterology, Ospedale Mauriziano “Umberto I” |
Risio M | Unit of Pathology, Istituto per la Ricerca e la Cura del Cancro, Candiolo |
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Bonelli, L., Sciallero, S., Senore, C. et al. History of negative colorectal endoscopy and risk of rectosigmoid neoplasms at screening flexible sigmoidoscopy. Int J Colorectal Dis 21, 105–113 (2006). https://doi.org/10.1007/s00384-005-0775-9
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DOI: https://doi.org/10.1007/s00384-005-0775-9