Reduced incidence and mortality from colorectal cancer with flexible-sigmoidoscopy screening: A meta-analysis

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 48; pp. 18466 - 18476
• Main Authors: Shroff, Jennifer, Thosani, Nirav, Batra, Sachin, Singh, Harminder, Guha, Sushovan
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 28.12.2014
• Subjects: Cancer; Colorectal; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - prevention & control; Early Detection of Cancer - instrumentation; Early Detection of Cancer - methods; Equipment Design; Flexible; Humans; Incidence; Meta-Analysis; Odds Ratio; Predictive Value of Tests; Randomize; Randomized Controlled Trials as Topic; Risk Factors; Sigmoidoscopes; sigmoidoscopy; Sigmoidoscopy - instrumentation; Sigmoidoscopy - methods; Colorectal Cancer; Randomized control trials; Flexible sigmoidoscopy; Mortality; Incidence; Meta-analysis
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i48.18466

AIM:To conduct a systematic review and meta-analysis of published population-based randomized controlled trials(RCTs).METHODS:RCTs evaluating the difference in mortality and incidence of colorectal cancer(CRC)between a screening flexible sigmoidoscopy(FS)group and control group(not assigned to screening FS)with a minimum 5 years median follow-up were identified by a search of MEDLINE and EMBASE databases and the Cochrane Central Register for Controlled Trials through August 2013.Random effects model was used for meta-analysis.RESULTS:Four RCTs with a total of 165659 patientsin the FS group and 249707 patients in the control group were included in meta-analysis.Intention-totreat analysis showed that there was a 22%risk reduction in total incidence of CRC(RR=0.78,95%CI:0.74-0.83),31%in distal CRC incidence(RR=0.69,95%CI:0.63-0.75),and 9%in proximal CRC incidence(RR=0.91,95%CI:0.83-0.99).Those who underwent screening FS were 18%less likely to be diagnosed with advanced CRC(OR=0.82,95%CI:0.71-0.94).There was a 28%risk reduction in overall CRC mortality(RR=0.72,95%CI:0.65-0.80)and 43%in distal CRC mortality(RR=0.57,95%CI:0.45-0.72).CONCLUSION:This meta-analysis suggests that screening FS can reduce the incidence of proximal and distal CRC and mortality from distal CRC along with reduction in diagnosis of advanced CRC.