Atkin W S, Cook C F, Cuzick J, Edwards R, Northover J M A, Wardle J
Lancet. 2002 Apr 13;359(9314):1291-300. doi: 10.1016/S0140-6736(02)08268-5.
This randomised controlled trial is examining the hypothesis that a single flexible sigmoidoscopy screening offered at around age 60 years can lower the incidence and mortality of colorectal cancer. We report here on acceptability, safety, feasibility, and yield.
Men and women aged 55-64 years, in 14 UK centres, who responded to a mailed questionnaire that they would attend for flexible sigmoidoscopy screening if invited, were randomly assigned screening or control (ratio one to two). The control group was not contacted. Small polyps were removed during screening, and colonoscopy was undertaken if high-risk polyps (three or more adenomas, size 1 cm or greater, villous, severely dysplastic, or malignant) were found.
Of 354,262 people asked about their interest in having flexible sigmoidoscopy screening, 194,726 (55%) responded positively, and 170,432 eligible individuals were randomised. Attendance among those assigned screening was 71% (40,674 of 57,254). 2131 (5%) were classified as high-risk and referred for colonoscopy; 38,525 with no polyps or only low-risk polyps detected were discharged. Distal adenomas were detected in 4931 (12.1%) and distal cancer in 131 (0.3%). Proximal adenomas were detected in 386 (18.8% of those undergoing colonoscopy) and proximal cancer in nine cases (0.4%). 62% of cancers were Dukes' stage A or locally excised. There was one perforation after flexible sigmoidoscopy and four after colonoscopy. An average of 48 people were screened, and two or three colonoscopy referrals generated, per centre each week. Interpretation Our flexible sigmoidoscopy screening regimen is acceptable, feasible, and safe. The prevalence of neoplasia is high, and colonoscopy referral rates of 5% are acceptable.
这项随机对照试验正在检验这样一个假设，即60岁左右进行一次乙状结肠镜检查可降低结直肠癌的发病率和死亡率。我们在此报告其可接受性、安全性、可行性及筛查结果。
英国14个中心的55至64岁男女，若回复邮寄问卷表示受邀时愿意接受乙状结肠镜检查筛查，则被随机分配至筛查组或对照组（比例为1:2）。对照组未被联系。筛查期间切除小息肉，若发现高危息肉（三个或更多腺瘤、直径1厘米或更大、绒毛状、重度发育异常或恶性）则进行结肠镜检查。
在354,262名被询问是否有兴趣接受乙状结肠镜检查筛查的人中，194,726人（55%）给予肯定答复，170,432名符合条件的个体被随机分组。被分配至筛查组的人中，71%（57,254人中的40,674人）前来参加。2131人（5%）被归类为高危并被转诊进行结肠镜检查；38,525人未发现息肉或仅发现低危息肉，被允许离开。在4931人（12.1%）中检测到远端腺瘤，131人（0.3%）中检测到远端癌症。在386人（接受结肠镜检查者的18.8%）中检测到近端腺瘤，9例（0.4%）中检测到近端癌症。62%的癌症为Dukes A期或局部切除。乙状结肠镜检查后有1例穿孔，结肠镜检查后有4例穿孔。每个中心每周平均筛查48人，产生两到三次结肠镜检查转诊。
我们的乙状结肠镜检查筛查方案是可接受的、可行的且安全的。瘤形成的患病率很高，5%的结肠镜检查转诊率是可以接受的。
