Colorectal Cancer Screening: Randomized Trials Are Essential to Support Recommendations
Authors: Michael Bretthauer, Robert E. Schoen, Amanda J. Cross, Paul F. Pinsky
Journal: Annals of Internal Medicine (2021)

EditorialsJanuary 2022Colorectal Cancer Screening: Randomized Trials Are Essential to Support RecommendationsMichael Bretthauer, MD, PhD, Robert E. Schoen, MD, MPH, Amanda J. Cross, PhD, Paul F. Pinsky, MPH, PhDMichael Bretthauer, MD, PhDClinical Effectiveness Research Group, University of Oslo and University of Tromsø, Oslo, NorwaySearch for more papers by this author, Robert E. Schoen, MD, MPHDepartments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, PennsylvaniaSearch for more papers by this author, Amanda J. Cross, PhDDepartment of Surgery and Cancer and the School of Public Health, Imperial College London, London, United KingdomSearch for more papers by this author, Paul F. Pinsky, MPH, PhDDivision of Cancer Prevention, National Cancer Institute, Bethesda, MarylandSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-3770 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Colorectal cancer screening for persons older than 45 or 50 years has been introduced in many countries. The most frequently used methods are endoscopy (today usually colonoscopy but also sigmoidoscopy) and fecal testing (1). The advantage of endoscopic screening versus fecal testing is that endoscopy aims to prevent colorectal cancer by removal of premalignant polyps, whereas fecal testing primarily targets detection of colorectal cancer at an early stage. Also, fecal testing needs to be repeated every year or every other year, whereas endoscopy is recommended with longer time intervals (5 or 10 years) (1).Although colonoscopy screening is recommended as ...References1. Qaseem A, Crandall CJ, Mustafa RA, et al; Clinical Guidelines Committee of the American College of Physicians. Screening for colorectal cancer in asymptomatic average-risk adults: a guidance statement from the American College of Physicians. Ann Intern Med. 2019;171:643-654. [PMID: 31683290] doi:10.7326/M19-0642 LinkGoogle Scholar2. Atkin W, Wooldrage K, Parkin DM, et al. Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: the UK Flexible Sigmoidoscopy Screening randomised controlled trial. Lancet. 2017;389:1299-1311. [PMID: 28236467] doi:10.1016/S0140-6736(17)30396-3 CrossrefMedlineGoogle Scholar3. Miller EA, Pinsky PF, Schoen RE, et al. Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: long-term follow-up of the randomised US PLCO cancer screening trial. Lancet Gastroenterol Hepatol. 2019;4:101-110. [PMID: 30502933] doi:10.1016/S2468-1253(18)30358-3 CrossrefMedlineGoogle Scholar4. Holme Ø, Løberg M, Kalager M, et al; NORCCAP Study Group. Long-term effectiveness of sigmoidoscopy screening on colorectal cancer incidence and mortality in women and men: a randomized trial. Ann Intern Med. 2018;168:775-782. [PMID: 29710125] doi:10.7326/M17-1441 LinkGoogle Scholar5. Segnan N, Armaroli P, Bonelli L, et al; SCORE Working Group. Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian randomized controlled trial—SCORE. J Natl Cancer Inst. 2011;103:1310-22. [PMID: 21852264] doi:10.1093/jnci/djr284 CrossrefMedlineGoogle Scholar6. Senore C, Riggi E, Armaroli P, et al. Long-term follow-up of the Italian flexible sigmoidoscopy screening trial. Ann Intern Med. 2022;175:36-45. doi:10.7326/M21-0977 Google Scholar7. Bretthauer M, Kalager M, Weinberg DS. From colorectal cancer screening guidelines to headlines: beware! [Letter]. Ann Intern Med. 2019;170:734. [PMID: 31108525] doi:10.7326/L19-0086 LinkGoogle Scholar8. Holme Ø, Schoen RE, Senore C, et al. Effectiveness of flexible sigmoidoscopy screening in men and women and different age groups: pooled analysis of randomised trials. BMJ. 2017;356:i6673. [PMID: 28087510] doi:10.1136/bmj.i6673 CrossrefMedlineGoogle Scholar9. Liang PS, Allison J, Ladabaum U, et al. Potential intended and unintended consequences of recommending initiation of colorectal cancer screening at age 45 years [Editorial]. Gastroenterology. 2018;155:950-954. [PMID: 30138614] doi:10.1053/j.gastro.2018.08.019 CrossrefMedlineGoogle Scholar10. Kalager M, Bretthauer M. Improving cancer screening programs. Science. 2020;367:143-144. [PMID: 31919207] doi:10.1126/science.aay3156 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Clinical Effectiveness Research Group, University of Oslo and University of Tromsø, Oslo, NorwayDepartments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, PennsylvaniaDepartment of Surgery and Cancer and the School of Public Health, Imperial College London, London, United KingdomDivision of Cancer Prevention, National Cancer Institute, Bethesda, MarylandDisclaimer: The authors are investigators of the U.S., United Kingdom, and Norwegian sigmoidoscopy screening trials mentioned in this article.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3770.Corresponding Author: Michael Bretthauer, MD, PhD, Department of Health Management and Health Economics, University of Oslo, Postbox 1089 Blindern, 0318 Oslo, Norway; e-mail, michael.[email protected]uio.no.This article was published at Annals.org on 9 November 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLong-Term Follow-up of the Italian Flexible Sigmoidoscopy Screening Trial Carlo Senore , Emilia Riggi , Paola Armaroli , Luigina Bonelli , Stefania Sciallero , Marco Zappa , Arrigo Arrigoni , Claudia Casella , Cristiano Crosta , Fabio Falcini , Franco Ferrero , Mario Fracchia , Orietta Giuliani , Mauro Risio , Antonio G. Russo , Carmen Beatriz Visioli , Stefano Rosso , Nereo Segnan , and Metrics January 2022Volume 175, Issue 1Page: 129-130KeywordsCancer preventionCancer screeningColonoscopyColorectal cancerEndoscopyFlexible sigmoidoscopyHealth economics ePublished: 9 November 2021 Issue Published: January 2022 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...