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Castells A, Quintero E, Álvarez C, Bujanda L, Cubiella J, Salas D, Lanas A, Carballo F, Morillas JD, Hernández C, Jover R, Hijona E, Portillo I, Enríquez-Navascués JM, Hernández V, Martínez-Turnes A, Menéndez-Villalva C, González-Mao C, Sala T, Ponce M, Andrés M, Teruel G, Peris A, Sopeña F, González-Rubio F, Seoane-Urgorri A, Grau J, Serradesanferm A, Pozo À, Pellisé M, Balaguer F, Ono A, Cruzado J, Pérez-Riquelme F, Alonso-Abreu I, Carrillo-Palau M, de la Vega-Prieto M, Iglesias R, Amador J, Blanco JM, Sastre R, Ferrándiz J, González-Hernández MJ, Andreu M, Bessa X. Rate of detection of advanced neoplasms in proximal colon by simulated sigmoidoscopy vs fecal immunochemical tests. Clin Gastroenterol Hepatol 2014; 12:1708-16.e4. [PMID: 24681078 DOI: 10.1016/j.cgh.2014.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS We compared the ability of biennial fecal immunochemical testing (FIT) and one-time sigmoidoscopy to detect colon side-specific advanced neoplasms in a population-based, multicenter, nationwide, randomized controlled trial. METHODS We identified asymptomatic men and women, 50-69 years old, through community health registries and randomly assigned them to groups that received a single colonoscopy examination or biennial FIT. Sigmoidoscopy yield was simulated from results obtained from the colonoscopy group, according to the criteria proposed in the UK Flexible Sigmoidoscopy Trial for colonoscopy referral. Patients who underwent FIT and were found to have ≥75 ng hemoglobin/mL were referred for colonoscopy. Data were analyzed from 5059 subjects in the colonoscopy group and 10,507 in the FIT group. The main outcome was rate of detection of any advanced neoplasm proximal to the splenic flexure. RESULTS Advanced neoplasms were detected in 317 subjects (6.3%) in the sigmoidoscopy simulation group compared with 288 (2.7%) in the FIT group (odds ratio for sigmoidoscopy, 2.29; 95% confidence interval, 1.93-2.70; P = .0001). Sigmoidoscopy also detected advanced distal neoplasia in a higher percentage of patients than FIT (odds ratio, 2.61; 95% confidence interval, 2.20-3.10; P = .0001). The methods did not differ significantly in identifying patients with advanced proximal neoplasms (odds ratio, 1.17; 95% confidence interval, 0.78-1.76; P = .44). This was probably due to the lower performance of both strategies in detecting patients with proximal lesions (sigmoidoscopy detected these in 19.1% of patients and FIT in 14.9% of patients) vs distal ones (sigmoidoscopy detected these in 86.8% of patients and FIT in 33.5% of patients). Sigmoidoscopy, but not FIT, detected proximal lesions in lower percentages of women (especially those 50-59 years old) than men. CONCLUSIONS Sigmoidoscopy and FIT have similar limitations in detecting advanced proximal neoplasms, which depend on patients' characteristics; sigmoidoscopy underperforms for women 50-59 years old. Screening strategies should be designed on the basis of target population to increase effectiveness and cost-effectiveness. ClinicalTrials.gov number: NCT00906997.
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Affiliation(s)
- Antoni Castells
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia.
| | - Enrique Quintero
- Department of Gastroenterology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife.
| | - Cristina Álvarez
- Department of Gastroenterology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Pompeu Fabra University, Barcelona, Catalonia
| | - Luis Bujanda
- Department of Gastroenterology, Donostia Hospital-Instituto Biodonostia, CIBERehd, University of Basque Country (UPV/EHU), San Sebastián
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Ourense
| | - Dolores Salas
- Colorectal Cancer Screening Program, Dirección General de Salud Pública, Conselleria de Sanitat, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region FISABIO, Valencia
| | - Angel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, CIBERehd, Zaragoza
| | - Fernando Carballo
- Unidad de Gestión Clínica de Digestivo, Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Universidad de Murcia, Murcia
| | | | - Cristina Hernández
- Department of Epidemiology and Evaluation, Parc de Salut Mar, IMIM, Barcelona, Catalonia
| | - Rodrigo Jover
- Gastroenterology Unit, Hospital General Universitario de Alicante, Alicante
| | - Elizabeth Hijona
- Department of Gastroenterology, Donostia Hospital-Instituto Biodonostia, CIBERehd, University of Basque Country (UPV/EHU), San Sebastián
| | - Isabel Portillo
- Centro Coordinador del Programa de Cribado de Cáncer Colorrectal, Organización Central de Osakidetza-Servicio Vasco de Salud, Bilbao
| | - José M Enríquez-Navascués
- Centro Coordinador del Programa de Cribado de Cáncer Colorrectal, Organización Central de Osakidetza-Servicio Vasco de Salud, Bilbao; Department of Surgery, Hospital Donostia-Instituto Biodonostia, University of Basque Country (UPV/EHU), San Sebastián
| | - Vicent Hernández
- Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo
| | | | | | - Carmen González-Mao
- Department of Clinical Analysis, Complexo Hospitalario Universitario de Vigo, Vigo
| | - Teresa Sala
- Colorectal Cancer Screening Program, Dirección General de Salud Pública, Conselleria de Sanitat, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region FISABIO, Valencia
| | - Marta Ponce
- Department of Gastroenterology, Hospital Universitario La Fe, Valencia
| | - Mercedes Andrés
- Colorectal Cancer Screening Program, Dirección General de Salud Pública, Conselleria de Sanitat, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region FISABIO, Valencia
| | - Gloria Teruel
- Colorectal Cancer Screening Program, Dirección General de Salud Pública, Conselleria de Sanitat, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region FISABIO, Valencia
| | - Antonio Peris
- Department of Gastroenterology, Consorcio Hospitalario de Castellón, Castellón
| | - Federico Sopeña
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, CIBERehd, Zaragoza
| | - Francisca González-Rubio
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, CIBERehd, Zaragoza
| | - Agustín Seoane-Urgorri
- Department of Gastroenterology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Pompeu Fabra University, Barcelona, Catalonia
| | - Jaume Grau
- Unitat d'Avaluació, Suport i Preventiva, Hospital Clínic, Barcelona, Catalonia
| | - Anna Serradesanferm
- Unitat d'Avaluació, Suport i Preventiva, Hospital Clínic, Barcelona, Catalonia
| | - Àngels Pozo
- Unitat d'Avaluació, Suport i Preventiva, Hospital Clínic, Barcelona, Catalonia
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia
| | - Akiko Ono
- Unidad de Gestión Clínica de Digestivo, Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia
| | - José Cruzado
- Colorectal Cancer Prevention Program of the Región de Murcia, Instituto Murciano de Investigación Biosanitaria, Servicio Murciano de Salud, Murcia
| | - Francisco Pérez-Riquelme
- Colorectal Cancer Prevention Program of the Región de Murcia, Instituto Murciano de Investigación Biosanitaria, Dirección General de Salud Pública, Consejería de Sanidad y Política Social, Murcia
| | - Inmaculada Alonso-Abreu
- Department of Gastroenterology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife
| | - Marta Carrillo-Palau
- Department of Gastroenterology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife
| | | | | | | | | | | | - Juan Ferrándiz
- Subdirección de Calidad, Dirección General Atención al Paciente, SERMAS, Madrid
| | | | - Montserrat Andreu
- Department of Gastroenterology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Pompeu Fabra University, Barcelona, Catalonia
| | - Xavier Bessa
- Department of Gastroenterology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Pompeu Fabra University, Barcelona, Catalonia
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