Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening

Nereo Segnan, Carlo Senore, Bruno Andreoni, Alberto Azzoni, Luigi Bisanti, Alessandro Cardelli, Guido Castiglione, Cristiano Crosta, Andrea Ederle, Alberto Fantin, Arnaldo Ferrari, Mario Fracchia, Franco Ferrero, Stefano Gasperoni, Serafino Recchia, Mauro Risio, Tiziana Rubeca, Giorgio Saracco, Marco Zappa et al.
Gastroenterology 2007, 132 (7): 2304-12

BACKGROUND & AIMS: We conducted a study to estimate population coverage and detection rate (DR) achievable through different strategies of colorectal cancer (CRC) screening.

METHODS: A population-based multicenter randomized trial comparing 3 strategies was used: (1) biennial immunologic fecal occult blood test (FIT), (2) "once only" sigmoidoscopy (FS), and (3) "once only" colonoscopy (TC). A random sample of men and women, aged 55 to 64 years, was drawn from general practitioners' (GP) rosters. Eligible subjects, randomized within GP, were mailed a personal invitation. Nonresponders in groups 2 and 3 were invited again at 12 and 24 months. Screenees with "high-risk" distal polyps (villous component >20%, high-grade dysplasia, CRC, size >or=10 mm, >2 adenomas) at FS, or with positive FIT, were referred for TC.

RESULTS: The attendance rate was 32.3% (1965/6075) for FIT, 32.3% (1944/6018) for FS, 26.5% (1597/6021) for TC. FIT detected 2 patients with CRC (0.1%) and 21 with an advanced adenoma (1.1%). The corresponding figures were as follows: 12 (0.6%) and 86 (4.5%) patients, respectively, for FS; 13 (0.8%) and 100 (6.3%) patients, respectively, for TC. To detect 1 advanced neoplasm, it would be necessary to invite 264 people with FIT, 60 with FS, 53 with TC. FS would have detected 27.3% of the proximal advanced neoplasms detected at TC. Assuming the same participation rate at TC as at FS, 48 TCs would be necessary to detect 1 additional advanced neoplasm missed by FS.

CONCLUSIONS: When participants are offered 1 screening test, participation is lower in a TC than in an FS program. However, DR of advanced neoplasia is higher with TC.

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