Paul S. Mueller, MD, MPH, FACP reviewing Holme Ø et al. BMJ 2017 Jan 13. Haug U. BMJ 2017 Jan 13.

In older women, benefit appears to be negligible.

Flexible sigmoidoscopy screening lowers colorectal cancer incidence and cancer-related mortality, but whether these effects differ by patient age and sex is unclear. In this pooled analysis of three randomized trials, international researchers compared the effectiveness of flexible sigmoidoscopy screening with usual care (i.e., no screening) in nearly 290,000 patients (age range, 50–74; 50% women).

After median follow-up of about 11 years, colorectal cancer incidence was significantly lower in the flexible sigmoidoscopy group than in the usual-care group (relative risk, 0.79, corresponding to roughly 2 or 3 fewer cases per 1000 people screened). In men, flexible sigmoidoscopy was associated with significantly lower risk for colorectal cancer (relative risk, 0.76), with no difference between younger men (age, <60) and older men. Flexible sigmoidoscopy also lowered colorectal cancer risk in women, but this effect was significant only in younger women (age, <60; RR, 0.71). In addition, flexible sigmoidoscopy was associated with significantly lower risk for colorectal cancer–related death in both younger and older men but only in younger women.

CITATION(S):

Holme Ø et al. Effectiveness of flexible sigmoidoscopy screening in men and women and different age groups: Pooled analysis of randomised trials. BMJ 2017 Jan 13; 356:i6673. 

Haug U.Flexible sigmoidoscopy screening for colorectal cancer. Different outcomes in men and women are a challenge for decision makers. BMJ 2017 Jan 13; 356:j75.

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