Study: Less Aggressive Colorectal Cancer Screening May Be More Practical

A less aggressive approach to looking at the intestine for early signs of colorectal cancer may be a more practical screening approach and thereby save lives, according to a report in the Journal of the National Cancer Institute.

The report comes from Italian researchers conducting the SCORE trial, a multicenter study seeking to measure whether a one-time sigmoidoscopy examination at age 60 is an acceptable alternative to a more invasive colonoscopy and regular follow-up screenings.

The American Cancer Society recommends that starting at age 60, every adult undergo a colonoscopy every 10 years. This requires that the patient undergo sedation while the doctor inserts a lighted, flexible tube to examine the entire intestine for polyps.

Sigmoidoscopy is much less demanding because it uses a shorter tube that inspects only the lower third of the colon for suspicious growths or precancerous polyps. About two-thirds of cancers are found in this area.

The theory being tested by the Italian study is that the less aggressive approach -- a one-time sigmoidoscopy rather than regular colonoscopies -- may result in many more screenings, thus saving lives even though fewer precancerous growths are detected.

In the report, researchers said they mailed a questionnaire to a random sample of 236,568 people aged 55 to 64 years to assess their eligibility for and interest in screening, and almost a quarter of these responded. They ultimately enrolled 34,292 in the trial, and assigned half to have a sigmoidoscopy.

Of the patients examined, colorectal cancers were found at a rate of 5.4 per thousand, according to the researchers.

But perhaps as important, the researchers reported that the pain associated with sigmoidoscopy was described as mild or less than expected by 83.3 percent of those screened.

"Sigmoidoscopy screening is generally acceptable to recipients and saf," the researchers concluded. "The high yield of advanced adenomas is consistent with the projected impact of sigmoidoscopy screening on colorectal cancer incidence."

Other Sources: Journal of the National Cancer Institute