Flexible sigmoidoscopy screening for colorectal cancer in average-risk subjects: a community-based pilot project.

OBJECTIVE

To test a pilot screening program for colorectal cancer.

DESIGN

Subjects, chosen at random and recruited by mail, were examined by flexible sigmoidoscopy.

PARTICIPANTS AND SETTING

Normal-risk, asymptomatic men and women aged 55-59 years recruited from the community, July to December, 1995.

MAIN OUTCOME MEASURES

Number of polyps detected and cancers diagnosed, and compliance with screening.

RESULTS

Letters of invitation were sent to 3500 subjects; of these, 2881 were eligible for inclusion in the study and 342 (12%) consented to participate. A further 3.5% of non-compliant subjects attended the screening program after a telephone survey assessing reasons for non-attendance. Common reasons for non-attendance were a lack of interest (30%) or a lack of time, mainly due to work commitments (28%). A third of subjects had polyps and 46% of these were adenomas. Three subjects were found to have adenocarcinoma: in two the cancer was confined to a polyp and treated with polypectomy, and one subject underwent anterior resection (overall prevalence of cancer, 0.9%). The median depth of insertion achieved with flexible sigmoidoscopy was 55 cm (range, 25-100 cm). Median pain level (on a scale of 0 = no pain to 10 = worst pain imaginable) was 2 (range, 0-8.5), and 99% of the subjects would have the test again if required.

CONCLUSIONS

Flexible sigmoidoscopy was well tolerated and had an acceptable detection rate of adenomatous polyps and early cancer. Subject compliance emerged as a major issue which requires further evaluation to maximise participation in future programs.