Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
Scottish Bowel Screening Centre, NHS Tayside, Kings Cross Hospital, Dundee, UK.
J Med Screen. 2020 Jun;27(2):59-67. doi: 10.1177/0969141319879955. Epub 2019 Nov 5.
Flexible sigmoidoscopy screening at around age 60 can reduce colorectal cancer incidence. Insufficient evidence exists on flexible sigmoidoscopy at age 60 in a population being offered biennial faecal occult blood test screening from age 50. This randomized controlled trial assessed if flexible sigmoidoscopy would be an effective adjunct to faecal occult blood test.
In the Scottish Bowel Screening Programme between June 2014 and December 2015, 51,769 individuals were randomized to be offered flexible sigmoidoscopy instead of faecal occult blood test at age 60 or to continue faecal occult blood test. Those not accepting flexible sigmoidoscopy and those with normal flexible sigmoidoscopy were offered faecal occult blood test. All with flexible sigmoidoscopy-detected neoplasia or a positive faecal occult blood test result were offered colonoscopy.
Overall flexible sigmoidoscopy uptake was 17.8%, higher in men than women, and decreased with increasing deprivation (25.7% in the least to 9.2% in the most deprived quintile). In those who underwent flexible sigmoidoscopy, detection rate for colorectal cancer was 0.13%, for adenoma 7.27%, and for total neoplasia 7.40%. In those who underwent colonoscopy after a positive flexible sigmoidoscopy, detection rate for colorectal cancer was 0.28%, adenoma 8.66%, and total neoplasia 8.83%. On an intention to screen basis, there was no difference in colorectal cancer detection rate between the study and control groups. Adenoma and total neoplasia detection rate were significantly higher in the study group, with odds ratios of 5.95 (95%CI: 4.69-7.56) and 5.10 (95%CI: 4.09-6.35), respectively.
In a single screening round at age 60, there was low uptake and neoplasia detection rate. Flexible sigmoidoscopy detected significantly more neoplasia than faecal occult blood test alone.
60 岁左右进行软性乙状结肠镜筛查可降低结直肠癌的发病率。在为 50 岁人群提供每两年一次粪便潜血试验筛查的情况下，60 岁时进行软性乙状结肠镜检查的证据不足。本随机对照试验评估了软性乙状结肠镜检查是否是粪便潜血试验的有效辅助手段。
在 2014 年 6 月至 2015 年 12 月期间的苏格兰肠道筛查计划中，将 51769 人随机分配，在 60 岁时接受软性乙状结肠镜检查而不是粪便潜血试验，或继续进行粪便潜血试验。那些不接受软性乙状结肠镜检查且软性乙状结肠镜检查正常的人被提供粪便潜血试验。所有软性乙状结肠镜检查发现的肿瘤或粪便潜血试验阳性的人都被提供结肠镜检查。
总体上，软性乙状结肠镜检查的接受率为 17.8%，男性高于女性，且随贫困程度的增加而降低（最贫困五分位数为 25.7%，最富裕五分位数为 9.2%）。在接受软性乙状结肠镜检查的人中，结直肠癌的检出率为 0.13%，腺瘤为 7.27%，总肿瘤为 7.40%。在软性乙状结肠镜检查阳性后接受结肠镜检查的人中，结直肠癌的检出率为 0.28%，腺瘤为 8.66%，总肿瘤为 8.83%。基于意向筛查基础，研究组和对照组的结直肠癌检出率无差异。研究组的腺瘤和总肿瘤检出率明显更高，优势比分别为 5.95（95%CI：4.69-7.56）和 5.10（95%CI：4.09-6.35）。
在 60 岁的单次筛查中，接受率和肿瘤检出率较低。软性乙状结肠镜检查比单独进行粪便潜血试验检测到的肿瘤更多。
