Holme Øyvind, Schoen Robert E, Senore Carlo, Segnan Nereo, Hoff Geir, Løberg Magnus, Bretthauer Michael, Adami Hans-Olov, Kalager Mette
Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway.
Clinical Effectiveness Research group, Institute of Health and Society, University of Oslo, Oslo, Norway.
BMJ. 2017 Jan 13;356:i6673. doi: 10.1136/bmj.i6673.
To compare the effectiveness of flexible sigmoidoscopy in screening for colorectal cancer by patient sex and age.
Pooled analysis of randomised trials (the US Prostate, Lung, Colorectal and Ovarian cancer screening trial (PLCO), the Italian Screening for Colon and Rectum trial (SCORE), and the Norwegian Colorectal Cancer Prevention trial (NORCCAP)).
Aggregated data were pooled from each randomised trial on incidence of colorectal cancer and mortality stratified by sex, age at screening, and colon subsite (distal v proximal).
Invited individuals aged 55-74 (PLCO), 55-64 (SCORE), and 50-64 (NORCCAP). Individuals were randomised to receive flexible sigmoidoscopy screening once only (SCORE and NORCCAP) or twice (PLCO), or receive usual care (no intervention).
287 928 individuals were included in the pooled analysis; 115 139 randomised to screening and 172 789 to usual care. Compliance rates were 58%, 63%, and 87% in SCORE, NORCCAP, and PLCO, respectively. Median follow-up was 10.5 to 12.1 years. Screening reduced the incidence of colorectal cancer in men (relative risk 0.76; 95% confidence interval 0.70 to 0.83) and women (0.83; 0.75 to 0.92). No difference in the effect of screening was seen between men younger than 60 and those older than 60. Screening reduced the incidence of colorectal cancer in women younger than 60 (relative risk 0.71; 95% confidence interval 0.59 to 0.84), but not significantly in those aged 60 or older (0.90; 0.80 to 1.02). Colorectal cancer mortality was significantly reduced in both younger and older men, and in women younger than 60. Screening reduced colorectal cancer incidence to a similar extent in the distal colon in men and women, but there was no effect of screening in the proximal colon in older women with a significant interaction between sex and age group (P=0.04).
Flexible sigmoidoscopy is an effective tool for colorectal cancer screening in men and younger women. The benefit is smaller and not statistically significant for women aged over 60; alternative screening methods that more effectively detect proximal tumours should be considered for these women.
比较乙状结肠镜检查在按患者性别和年龄筛查结直肠癌方面的有效性。
对随机试验（美国前列腺、肺、结直肠癌和卵巢癌筛查试验（PLCO）、意大利结直肠癌筛查试验（SCORE）以及挪威结直肠癌预防试验（NORCCAP））进行汇总分析。
从每项随机试验中汇总关于结直肠癌发病率和死亡率的数据，并按性别、筛查时的年龄以及结肠部位（远端与近端）进行分层。
受邀个体年龄在55 - 74岁（PLCO）、55 - 64岁（SCORE）以及50 - 64岁（NORCCAP）。个体被随机分配接受仅一次乙状结肠镜检查筛查（SCORE和NORCCAP）或两次（PLCO），或者接受常规护理（无干预）。
287928名个体被纳入汇总分析；115139名被随机分配接受筛查，172789名接受常规护理。SCORE、NORCCAP和PLCO的依从率分别为58%、63%和87%。中位随访时间为10.5至12.1年。筛查降低了男性（相对风险0.76；95%置信区间0.70至0.83）和女性（0.83；0.75至0.92）结直肠癌的发病率。60岁以下男性和60岁以上男性在筛查效果上无差异。筛查降低了60岁以下女性结直肠癌的发病率（相对风险0.71；95%置信区间0.59至0.84），但在60岁及以上女性中未显著降低（0.90；0.80至1.02）。60岁以下及以上男性以及60岁以下女性的结直肠癌死亡率均显著降低。筛查在男性和女性的远端结肠中降低结直肠癌发病率的程度相似，但在老年女性的近端结肠中筛查无效果，且性别和年龄组之间存在显著交互作用（P = 0.04）。
乙状结肠镜检查是男性和年轻女性结直肠癌筛查的有效工具。对于60岁以上女性，益处较小且无统计学意义；对于这些女性，应考虑更有效地检测近端肿瘤的替代筛查方法。
