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Sigmoidoscopy screening for colorectal cancer

BMJ 2009; 338 doi: (Published 31 May 2009) Cite this as: BMJ 2009;338:b2084
  1. Thomas F Imperiale, professor of medicine1, research scientist2
  1. 1Indiana University Medical Center, Indianapolis, IN, USA
  2. 2Regenstrief Institute, Indianapolis, IN 46202-5121, USA
  1. timperia{at}

    May reduce mortality, but longer term results are awaited

    Evidence supporting colorectal screening, aside from randomised trials of faecal occult blood testing, comes mainly from observational studies. In the linked paper (doi:10.1136/bmj.b1846) interim results of the Norwegian Colorectal Cancer Prevention (NORCCAP) trial are presented.1 NORCCAP is one of three ongoing trials of once only screening sigmoidoscopy.1 2 3 The findings suggest that the intervention may be effective in reducing mortality from colorectal cancer.

    The NORCCAP trial randomised 55 736 people aged 55-64 years to usual care or to once only flexible sigmoidoscopy with or without a single round of immunochemical faecal occult blood testing. The primary outcome for this first report is 7 year cumulative incidence of colorectal cancer (anywhere in the colon); the secondary outcome is 6 year mortality from colorectal cancer. Colonoscopy, which was done in 21% of patients screened, was recommended for people with a positive screening result, defined as any polyp 10 mm or larger in diameter, any histologically verified adenoma or carcinoma, or a positive faecal occult blood test. Follow-up was obtained from the Cancer Registry of Norway and the Norwegian Cause of Death Registry, both of which …

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