Long-Term Follow-up of the Italian Flexible Sigmoidoscopy Screening Trial

Senore, Carlo; Riggi, Emilia; Armaroli, Paola; Bonelli, Luigina; Sciallero, Stefania; Zappa, Marco; Arrigoni, Arrigo; Casella, Claudia; Crosta, C.; Falcini, Fabio; Ferrero, Franco; Fracchia, M.; Giuliani, Orietta; Risio, Mauro; Russo, Antonio; Visioli, Carmen Beatriz; Rosso, Stefano; Segnan, Nereo; Carnevali, Andrea; A, Agnolucci; Ceccatelli, P; Mirri, Federica; Penna, A. Michael La; Genta, Giovanna; Marutti, Anna; Guelfi, Anita; Gatteschi, Beatrice; Fiori, Giancarla; Fabbretti, Giovanna; Gasperoni, Stefano; Bertone, A.; Pennazio, Marco; Spandre, M.; Silvani, Marco; Demaria, Moreno

doi:10.7326/m21-0977

Cited by 30 publications

(47 citation statements)

References 26 publications

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“…It is important to stress that this study was not designed to show or prove potential benefits of screening on CRC burden; these have been consistently shown elsewhere by substantial effects on CRC incidence and mortality. 16 , 17 , 18 , 19 , 20 , 21 , 22 In fact, the higher survival of screen-detected cases may partly reflect lead-time bias (mere advancement of diagnosis through screening without improving the chances of prolonged life), length-time bias (higher proportions of slowly growing and less aggressive tumours among screen-detected cases), or overdiagnosis bias (a sort of length-time bias, in which a tumour that would have never caused symptoms or death is found at screening). 23 Length-time bias may indeed help explain the higher survival even within each stage for patients with screen-detected cancer than for patients with non-screen-detected cancer.…”

Section: Discussionmentioning

confidence: 99%

Overall and stage-specific survival of patients with screen-detected colorectal cancer in European countries: A population-based study in 9 countries

Cardoso

Guo

Heisser

et al. 2022

The Lancet Regional Health - Europe

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Section: Discussionmentioning

confidence: 99%

Overall and stage-specific survival of patients with screen-detected colorectal cancer in European countries: A population-based study in 9 countries

Cardoso

Guo

Heisser

et al. 2022

The Lancet Regional Health - Europe

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“…Flexible sigmoidoscopy is currently not used in organised screening programmes in this region, although its effectiveness in reducing CRC incidence and mortality in the distal colon is demonstrated by randomised trials. This is probably related to increased accessibility to colonoscopy and the concern about increasing prevalence of proximal colorectal neoplasms 25–28. Guaiac-based faecal occult blood tests are no longer used and have been largely replaced by FIT owing to its convenience of use, high screening uptake, and better sensitivity and specificity for CRC.…”

Section: Resultsmentioning

confidence: 99%

Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance

Sung¹,

Chiu

Lieberman

et al. 2022

Gut

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The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.

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“…We therefore calculated model-based IRR APPs by deriving sex- and age-specific numbers of incident cases for intervention and control groups, calculating the incidence rate as number of cases per number of patient-years for each group, and finally calculating the ratio of incidence rates of the intervention (screened) group and the control group. Outcomes were compared to those extracted for the actual SCORE trial [6]. Results were considered consistent if modelled estimates were within the 95%-confidence intervals (CI) of the corresponding outcomes reported for the SCORE trial.…”

Section: Methodsmentioning

confidence: 99%

“…The effectiveness of screening sigmoidoscopy to reduce CRC risks has been studied across in total four RCTs, with reported cumulative incidence reductions after median 14-17 years of follow-up ranging from 18-26% in intention-to-screen and 33-35% in per-protocol analysis [3][4][5][6][7]). All RCTs have in common that the preventive effect of screening sigmoidoscopy only transpired after 4-5 years.…”

Section: Findings In Contextmentioning

confidence: 99%

Disclosing the true impact of screening endoscopy on colorectal cancer incidence

Heisser

Senore

Hoffmeister

et al. 2022

Preprint

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Objectives Randomized trials have demonstrated reduction of colorectal cancer (CRC) incidence by screening endoscopy. However, measured reduction underestimates true reduction due to inclusion of preclinical cases already present at recruitment. We aimed to quantify the true impact of screening endoscopy on reducing the CRC incidence. Design Simulation study replicating reported CRC incidence by SCORE, a large, randomized screening sigmoidoscopy trial, and deriving expected incidence after excluding cases that manifested during follow-up but were already prevalent at baseline. Setting Offer of a single flexible sigmoidoscopy in an organised, population-based screening setting. Participants Simulated, sex- and age-matched SCORE trial population (intervention group, N=17,136, control group, N=17,136, 50% women, ages 55-64 at baseline). Interventions Screening flexible sigmoidoscopy versus no screening. Main outcome measure 'True' (i.e., unbiased, excluding prevalent cancers at baseline) and 'apparent' (i.e., as reported) incidence rate ratios (IRR) for screening versus no screening. Results In the initial years after randomization, apparent cumulative incidence in the screening group was higher than in the control group due to inclusion of a large proportion of prevalent cancers. In the longer run, apparent cumulative incidence was lower in the screening group, but this incidence reduction was still much lower than true incidence reduction due to inclusion of prevalent cases in calculation of apparent cumulative incidence. In intention-to-screen analysis, apparent/true risk reductions after 8, 11 and 15 years of follow-up were 16%/31%, 20%/28%, and 21/25%, respectively. In per-protocol analyses, respective apparent/true risk reductions were 28%/54%, 34%/49%, and 35%/44%. Estimated underestimation of true incidence was similar among men and women and among age groups 55-59 and 60-64. Conclusions The preventive effect of screening endoscopy is likely much stronger than reflected in the reported apparent IRRs. Published findings of randomized screening trials underestimate the true preventive effective of screening endoscopy even after 15 year or longer follow-up.

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Long-Term Follow-up of the Italian Flexible Sigmoidoscopy Screening Trial

Cited by 30 publications

References 26 publications

Overall and stage-specific survival of patients with screen-detected colorectal cancer in European countries: A population-based study in 9 countries

Overall and stage-specific survival of patients with screen-detected colorectal cancer in European countries: A population-based study in 9 countries

Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance

Disclosing the true impact of screening endoscopy on colorectal cancer incidence

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