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A Case–Control Study of Screening Sigmoidoscopy and Mortality from Colorectal Cancer

A Case–Control Study of Screening Sigmoidoscopy and Mortality from Colorectal Cancer AbstractBackgroundThe efficacy of sigmoidoscopic screening in reducing mortality from colorectal cancer remains uncertain. A randomized trial would be ideal for clarifying this issue but is very difficult to conduct. Case–control studies provide an alternative method of estimating the efficacy of screening sigmoidoscopy.MethodsUsing data on the 261 members of the Kaiser Permanente Medical Care Program who died of cancer of the rectum or distal colon from 1971 to 1988, we examined the use of screening by rigid sigmoidoscopy during the 10 years before the diagnosis and compared it with the use of screening in 868 control subjects matched with the case subjects for age and sex.ResultsOnly 8.8 percent of the case subjects had undergone screening by sigmoidoscopy, as compared with 24.2 percent of the controls (matched odds ratio, 0.30; 95 percent confidence interval, 0.19 to 0.48). Adjustment for potential confounding factors increased the odds ratio to 0.41 (95 percent confidence interval, 0.25 to 0.69). The negative association was as strong when the most recent sigmoidoscopy was 9 to 10 years before diagnosis as it was when examinations were more recent. By contrast, for 268 subjects with fatal colon cancer above the reach of the sigmoidoscope and for 268 controls, the adjusted odds ratio was 0.96 (95 percent confidence interval, 0.61 to 1.50). The specificity of the negative association for cancer within the reach of the sigmoidoscope is consistent with a true efficacy of screening rather than a confounding by unmeasured selection factors.ConclusionsScreening by sigmoidoscopy can reduce mortality from cancer of the rectum and distal colon. Screening once every 10 years may be nearly as efficacious as more frequent screening. (N Engl J Med 1992; 326:653–7.) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The New England Journal of Medicine The New England Journal of Medicine

A Case–Control Study of Screening Sigmoidoscopy and Mortality from Colorectal Cancer

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References (23)

Publisher
The New England Journal of Medicine
ISSN
0028-4793
eISSN
1533-4406
DOI
10.1056/NEJM199203053261001
pmid
1736103
Publisher site
See Article on Publisher Site

Abstract

AbstractBackgroundThe efficacy of sigmoidoscopic screening in reducing mortality from colorectal cancer remains uncertain. A randomized trial would be ideal for clarifying this issue but is very difficult to conduct. Case–control studies provide an alternative method of estimating the efficacy of screening sigmoidoscopy.MethodsUsing data on the 261 members of the Kaiser Permanente Medical Care Program who died of cancer of the rectum or distal colon from 1971 to 1988, we examined the use of screening by rigid sigmoidoscopy during the 10 years before the diagnosis and compared it with the use of screening in 868 control subjects matched with the case subjects for age and sex.ResultsOnly 8.8 percent of the case subjects had undergone screening by sigmoidoscopy, as compared with 24.2 percent of the controls (matched odds ratio, 0.30; 95 percent confidence interval, 0.19 to 0.48). Adjustment for potential confounding factors increased the odds ratio to 0.41 (95 percent confidence interval, 0.25 to 0.69). The negative association was as strong when the most recent sigmoidoscopy was 9 to 10 years before diagnosis as it was when examinations were more recent. By contrast, for 268 subjects with fatal colon cancer above the reach of the sigmoidoscope and for 268 controls, the adjusted odds ratio was 0.96 (95 percent confidence interval, 0.61 to 1.50). The specificity of the negative association for cancer within the reach of the sigmoidoscope is consistent with a true efficacy of screening rather than a confounding by unmeasured selection factors.ConclusionsScreening by sigmoidoscopy can reduce mortality from cancer of the rectum and distal colon. Screening once every 10 years may be nearly as efficacious as more frequent screening. (N Engl J Med 1992; 326:653–7.)

Journal

The New England Journal of MedicineThe New England Journal of Medicine

Published: Mar 5, 1992

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