Bonelli Luigina, Sciallero Stefania, Senore Carlo, Zappa Marco, Aste Hugo, Andreoni Bruno, Angioli Donato, Ferraris Roberto, Gasperoni Stefano, Malfitana Giuseppe, Pennazio Marco, Atkin Wendy, Segnan Nereo
Secondary Prevention and Screening, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
Int J Colorectal Dis. 2006 Mar;21(2):105-13. doi: 10.1007/s00384-005-0775-9. Epub 2005 Apr 28.
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.
乙状结肠镜筛查可降低结直肠癌的发病率和死亡率。最佳的再次筛查间隔尚未确定。本研究旨在评估55 - 64岁报告筛查前结肠镜检查结果为阴性的受试者，在进行筛查性乙状结肠镜检查时发生远端进展性腺瘤（直径≥10 mm，绒毛成分>20%，高级别异型增生）和癌症的风险。
8202名年龄在55 - 64岁之间的受试者，他们在意大利的SCORE试验中接受了筛查性乙状结肠镜检查，并且能够报告其既往结肠镜检查史。
8202名受试者中有883名（10.8%）报告至少有一次筛查前结肠镜检查结果为阴性：其中，在上次报告的检查与筛查性乙状结肠镜检查之间间隔3 - 5年、6 - 10年和>10年之后，进展性腺瘤的绝对风险分别为1.5%、0.9%和0.9%；检测到1例癌症（0.1%）。在7319名未报告筛查前结肠镜检查的受试者中，进展性腺瘤和癌症的风险分别为3.2%和0.4%。与未进行过结直肠检查的受试者相比，既往进行过结直肠检查的受试者发生进展性腺瘤的风险降低了65%（OR = 0.35，95%CI 0.18 - 0.66），发生癌症的风险降低了71%（OR = 0.29，95%CI 0.04 - 1.12）。对于无结直肠癌家族史的受试者，这种风险的显著降低持续了长达十年。观察到的益处似乎不适用于有结直肠癌家族史的受试者。
我们的结果与以下假设一致，即对于没有结直肠癌特定危险因素的受试者，乙状结肠镜筛查之间的间隔可以安全地延长至5年以上。
