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History of negative colorectal endoscopy and risk of rectosigmoid neoplasms at screening flexible sigmoidoscopy

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

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.

Patients

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.

Results

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.

Conclusions

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.

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References

  1. Pisani P, Parkin DM, Bray F, Ferlay J (1999) Estimates of the worldwide mortality from 25 cancers in 1990. Int J Cancer 83:18–29

    Article  CAS  PubMed  Google Scholar 

  2. Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J (1997) Cancer incidence in five continents. IARC Sci Publ VII(143)

  3. Decarli A, La Vecchia C, Cislaghi C, Negri E (1998) Cancer mortality in Italy, 1994, and an overview of trends from 1955 to 1994. Tumori 84:312–334

    CAS  PubMed  Google Scholar 

  4. Capocaccia R, De Angelis R, Frova L, Gatta G, Sant M, Micheli A, Berrino F, Conti E, Gafa L, Roncucci L, Verdecchia A (1997) Estimation and projection of colorectal cancer trends in Italy. Int J Epidemiol 26:924–932

    Article  CAS  PubMed  Google Scholar 

  5. Muto T, Bussey HJ, Morson BC (1975) The evolution of cancer of the colon and rectum. Cancer 36:2251–2270

    CAS  PubMed  Google Scholar 

  6. Levi F, Randimbison L, La Vecchia C (1993) Incidence of colorectal cancer following adenomatous polyps of the large intestine. Int J Cancer 55:415–418

    CAS  PubMed  Google Scholar 

  7. Chen CD, Yen MF, Wang WM, Wong JM, Chen TH (2003) A case-cohort study for the disease natural history of adenoma–carcinoma and de novo carcinoma and surveillance of colon and rectum after polypectomy: implication for efficacy of colonoscopy. Br J Cancer 88:1866–1873

    Article  PubMed  Google Scholar 

  8. Stryker SJ (1987) Natural history of untreated colonic polyps. Gastroenterology 93:1009–1013

    CAS  PubMed  Google Scholar 

  9. Atkin WS, Morson BC, Cuzick J (1992) Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 326:658–662

    CAS  PubMed  Google Scholar 

  10. Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Shapiro M, Bond JH, Panish JF, Acrkroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET, The National Polyp Study Working Group (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981

    Article  CAS  PubMed  Google Scholar 

  11. Muller A, Sonnenberg A (1995) Prevention of colorectal cancer by flexible endoscopy and polypectomy. A case-control study of 32,702 veterans. Ann Intern Med 123:904–910

    CAS  PubMed  Google Scholar 

  12. Kavanagh AM, Giovannucci EL, Fuchs CS, Colditz GA (1998) Screening endoscopy and risk of colorectal cancer in United States men. Cancer Causes Control 9:455–462

    Article  CAS  PubMed  Google Scholar 

  13. Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM (1992) Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst 84:1572–1575

    CAS  PubMed  Google Scholar 

  14. Selby JV, Friedman GD, Quesenberry CP, Weiss NS (1992) A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 26:653–657

    Google Scholar 

  15. Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, Ganiats T, Levin T, Woolf S, Johnson D, Kirk L, Litin S, Simmang C, Gastrointestinal Consortium Panel (2003) Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology 124:544–560

    Article  PubMed  Google Scholar 

  16. Atkin WS, Cuzick J, Northover JM, Whynes DK (1993) Prevention of colorectal cancer by “once only” sigmoidoscopy. Lancet 341:736–740

    Article  CAS  PubMed  Google Scholar 

  17. UK Flexible Sigmoidoscopy Screening Trial Investigators (2002) Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial. Lancet 359:1291–1300

    Google Scholar 

  18. Segnan N, Senore C, Andreoni B, Aste H, Bonelli L, Crosta C, Ferraris R, Gasperoni S, Penna A, Risio M, Rossini FP, Sciallero S, Zappa M, Atkin WS, SCORE Working Group–Italy (2002) Baseline findings of the Italian multicenter randomized controlled trial of “once-only sigmoidoscopy”—SCORE. J Natl Cancer Inst 94:1763–1772

    PubMed  Google Scholar 

  19. Jass J, Sobin LH (1989) Histological typing of intestinal tumours, 2nd edn. Springer, Berlin Heidelberg New York

    Google Scholar 

  20. Fleiss JL (1981) Statistical methods for rates and proportions, 2nd edn. Wiley, New York, NY

    Google Scholar 

  21. Schlesselman JJ (1982) Case-control studies. Design, conduct, analysis. Oxford University Press, New York

    Google Scholar 

  22. Norusis MJ (1992) SPSS for Windows, Professional Statistics, Release 5. SPSS Inc., Chicago

    Google Scholar 

  23. Newcomb PA, Storer BE, Morimoto LM, Templeton A, Potter JD (2003) Long-term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidence. J Natl Cancer Inst 95:622–625

    PubMed  Google Scholar 

  24. Brenner H, Arndt V, Sturmer T, Stegmaier C, Ziegler H, Dhom G (2001) Long-lasting reduction of colorectal cancer following screening endoscopy. Br J Cancer 85:972–976

    Article  CAS  PubMed  Google Scholar 

  25. Gordon NP, Hiatt RA, Lampert DI (1993) Concordance of self-reported data and medical record audit for six cancer screening procedures. J Natl Cancer Inst 85:566–570

    CAS  PubMed  Google Scholar 

  26. Baier M, Calonge N, Cutter G, McClatchey M, Schoentgen S, Hines S, Marcus A, Ahnen D (2000) Validity of self-reported colorectal cancer screening behavior. Cancer Epidemiol Biomark Prev 9:229–232

    CAS  Google Scholar 

  27. Yeazel MW, Church TR, Jones RM, Kochevar LK, Watt GD, Cordes JE, Engelhard D, Mongin SJ (2004) Colorectal cancer screening adherence in a general population. Cancer Epidemiol Biomark Prev 13:654–657

    Google Scholar 

  28. Seeff LC, Shapiro JA, Nadel MR (2002) Are we doing enough to screen for colorectal cancer? Findings from the 1999 Behavioral risk factor surveillance system. J Fam Pract 1:761–766

    Google Scholar 

  29. Bonelli L, Martines H, Conio M, Bruzzi P, Aste H (1988) Family history of colorectal cancer as a risk factor for benign and malignant tumours of the large bowel. A case-control study. Int J Cancer 41:513–517

    CAS  PubMed  Google Scholar 

  30. Ponz de Leon M, Antonioli A, Ascari A, Zanghieri G, Sacchetti C (1987) Incidence and familial occurrence of colorectal cancer and polyps in a health-care district of northern Italy. Cancer 60:2848–2859

    CAS  PubMed  Google Scholar 

  31. Ferraris R, Senore C, Fracchia M, Sciallero S, Bonelli L, Atkin WS, Segnan N, SCORE Working Group, Italy (2004) Predictive value of rectal bleeding for distal colonic neoplastic lesions in a screened population. Eur J Cancer 40:245–252

    Article  CAS  PubMed  Google Scholar 

  32. Crosland A, Jones R (1995) Rectal bleeding: prevalence and consultation behaviour. BMJ 311:486–488

    CAS  PubMed  Google Scholar 

  33. Jones R, Lydeard S (1992) Irritable bowel syndrome in the general population. BMJ 304:87–90

    CAS  PubMed  Google Scholar 

  34. Gaburri M, Bassotti G, Bacci G, Cinti A, Bosso R, Ceccarelli P, Paolocci N, Pelli MA, Morelli A (1989) Functional gut disorders and health care seeking behaviour in an Italian non-patients population. Recent Prog Med 5:241–244

    Google Scholar 

  35. Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ III (1993) Functional constipation and outlet delay: a population based study. Gastroenterology 105:781–790

    CAS  PubMed  Google Scholar 

  36. Blom J, Liden A, Jeppsson B, Holmberg L, Pahlman L (2002) Compliance and findings in a Swedish population screened for colorectal cancer with sigmoidoscopy. Eur J Surg Oncol 28:827–831

    Article  CAS  PubMed  Google Scholar 

  37. Thiis-Evensen E, Hoff GS, Sauar J, Langmark F, Majak BM, Vatn MH (1999) Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scand J Gastroenterol 34:414–420

    Article  CAS  PubMed  Google Scholar 

  38. Schoen RE, Pinsky PF, Weissfeld JL, Bresalier RS, Church T, Prorok P, Gohagan JK, Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Group (2003) Results of repeat sigmoidoscopy 3 years after a negative examination. JAMA 290:41–48

    Article  PubMed  Google Scholar 

  39. Strum WB (2003) Incidence of advanced adenomas of the rectosigmoid colon three years and five years after negative flexible sigmoidoscopy in 4010 patients. Dig Dis Sci 48:2278–2283

    Article  PubMed  Google Scholar 

  40. Paillot B, Czernichow P, Michel P, Merle V, Queuniet AM, Duval C, Daubert H (1999) Incidence of rectosigmoid adenomatous polyps in subjects without prior colorectal adenomas or cancer: a prospective cohort study. Gut 44:372–376

    CAS  PubMed  Google Scholar 

  41. Platell CFE, Philpoo G, Olynyk JK (2002) Flexible sigmoidoscopy screening for colorectal neoplasia in average-risk people: evaluation of a five-year rescreening interval. Med J Aust 176:371–373

    PubMed  Google Scholar 

  42. Rex DK, Cummings OW, Helper DJ, Nowak TV, McGill JM, Chiao GZ, Kwo PY, Gottlieb KT, Ikenberry SO, Gress FG, Lehman GA, Born LJ (1996) 5-Year incidence of adenomas after negative colonoscopy in asymptomatic average-risk persons. Gastroenterology 111:1178–1181

    CAS  PubMed  Google Scholar 

  43. Yoshinaga M, Watabe R, Yanagisawa J, Harada N, Motomura S, Nawata H, Ikeda K (2001) The interval between flexible sigmoidoscopy examinations can be expanded beyond five years. Hepatogastroenterology 48:437–439

    CAS  Google Scholar 

  44. Hixson LJ, Fennerty MB, Sampliner RE, McGee D, Garewal H (1990) Prospective study of the frequency and size distribution of polyps missed by colonoscopy. J Natl Cancer Inst 82:1769–1772

    CAS  PubMed  Google Scholar 

  45. Rex DK, Cutler CS, Lemmel GT, Rahmani EY, Clark DW, Helper DJ, Lehman GA, Mark DG (1997) Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology 112:24–28

    CAS  PubMed  Google Scholar 

  46. Fossi S, Bazzoli F, Ricciardiello L, Nicolini G, Zagari RM, Pozzato P, Palli D, Roda E (2001) Incidence and recurrence rates of colorectal adenomas in first-degree asymptomatic relatives of patients with colon cancer. Am J Gastroenterol 96:1601–1604

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The SCORE trial was supported by grants from the Italian Association for Cancer Research (AIRC 1995–97), the Italian National Research Council (CNR grant no. 95.00539.PF39 and no. 96.00736.PF39) Ministry of Public Health and the Istituto Oncologico Romagnolo (Rimini).

SOFAR s.p.a. provided the enema supply for the patients enrolled in the study.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Luigina Bonelli.

Additional information

Members of the SCORE Working Group are provided in Appendix A

The SCORE Working Group-Italy

The SCORE Working Group-Italy

Arezzo

 Ghezzi P

Centro Oncologico

 Sforza V

Unit of Pathology, Centro Oncologico

 Agnolucci A

Unit of Gastroenterology, Ospedale S Donato

 Ceccatelli P

Unit of Gastroenterology, Ospedale S Donato

Biella

 Penna A

Fondo “ E Tempia”–ASL 12

 Azzoni A

Unit of Gastroenterology, Ospedale degli Infermi–ASL 12

 Ferrero F

Unit of Gastroenterology, Ospedale degli Infermi–ASL 12

 Giudici M

Unit of Pathology, Ospedale degli Infermi–ASL 12

Genoa

 Munizzi F

Unit of Gastroenterology and Nutrition, National Institute for Cancer Research

 Saccomanno S

Unit of Gastroenterology and Nutrition, National Institute for Cancer Research

 Pugliese V

Unit of Gastroenterology and Nutrition, National Institute for Cancer Research and Department of Oncology Biology and Genetics–University of Genova

 Nicora AM

Unit of Clinical Epidemiology, National Institute for Cancer Research

Milano

 Bargiggia S

Endoscopy Unit, Sacco Hospital, Milan

 Gerosa C

Unit of Gastroenterology, S Carlo Hospital, Milan

 Minoli G

Unit of Gastroenterology, Valduce Hospital, Como

 Penagini R

Endoscopy Unit, Policlinico Hospital, Milan

 Prada A

Unit of Gastroenterology, General Hospital, Rho

 Viale E

Endoscopy Unit, S Raffaele Hospital, Milan

 Crosta C

Unit of Gastroenterology, European Institute of Oncology

 Fiori G

Unit of Gastroenterology, European Institute of Oncology

 Bosari S

Unit of Pathology, European Institute of Oncology

 Viale G

Unit of Pathology, European Institute of Oncology

 Marzona L

Surgery II, European Institute of Oncology and University of Milano

 Lotti M

Surgery II, European Institute of Oncology and University of Milano

Rimini

 Giuliani O

Unit of Gastroenterology, Infermi Hospital

 Cardelli A

Unit of Gastroenterology, Infermi Hospital

 Rinaldi P

Pathology Unit, Infermi Hospital

Turin

 Arrigoni A

Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1

 Bertone A

Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1

 Cavallero M

Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1

 Gemme C

Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1

 Spandre M

Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1

 Rossini FP

Unit of Gastroenterology, Ospedale S. Giovanni Antica Sede, ASL 1

 Berardengo E

Unit of Pathology, Ospedale S Giovanni Antica Sede, ASL 1

 Coppola F

Unit of Gastroenterology, Ospedale Mauriziano “Umberto I”

 Fracchia M

Unit of Gastroenterology, Ospedale Mauriziano “Umberto I”

 Galatola G

Unit of Gastroenterology, Ospedale Mauriziano “Umberto I”

 Pera A

Unit of Gastroenterology, Ospedale Mauriziano “Umberto I”

 Risio M

Unit of Pathology, Istituto per la Ricerca e la Cura del Cancro, Candiolo

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Bonelli, L., Sciallero, S., Senore, C. et al. History of negative colorectal endoscopy and risk of rectosigmoid neoplasms at screening flexible sigmoidoscopy. Int J Colorectal Dis 21, 105–113 (2006). https://doi.org/10.1007/s00384-005-0775-9

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  • DOI: https://doi.org/10.1007/s00384-005-0775-9

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