Additional benefit seen for colonoscopy versus sigmoidoscopy

There may be a limited additional colorectal cancer (CRC) screening benefit for colonoscopy compared with sigmoidoscopy, according to a study published online Feb. 29 in JAMA Network Open.

Frederik E. Juul, M.D., Ph.D., from the University of Oslo in Norway, and colleagues estimated the additional screening benefit of colonoscopy compared with sigmoidoscopy in a comparative effectiveness simulation study using pooled data for 358,204 men and women. Participants were randomly assigned to sigmoidoscopy screening or usual care.

The researchers found that colonoscopy prevented an estimated 50 CRC cases per 100,000 person-years, corresponding to a 30% incidence reduction, and prevented an estimated 15 CRC deaths per 100,000 person-years, corresponding to a 32% mortality reduction (rate ratios, 0.70 and 0.68, respectively). Compared with sigmoidoscopy, the additional benefit of colonoscopy screening was 12 fewer CRC cases and four fewer CRC deaths per 100,000 person-years, corresponding to reductions of 6.9 and 7.6 percentage points for CRC incidence and mortality. To prevent one CRC case and one CRC death, the number needed to switch from sigmoidoscopy to colonoscopy screening was 560 and 1,611, respectively.

"Compared with sigmoidoscopy screening, colonoscopy screening provided 6.9 percentage points additional reductions in CRC incidence and 7.6 percentage points additional reductions in CRC mortality, which means that the additional preventive effect of colonoscopy compared with sigmoidoscopy was less than what was achieved by introducing sigmoidoscopy screening where no screening existed," the authors write.

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