Screening colonoscopy and flexible sigmoidoscopy for reduction of colorectal cancer incidence: A case-control study

Autoři: Cynthia W. Ko aff001;  V. Paul Doria-Rose aff002;  Michael J. Barrett aff003;  Aruna Kamineni aff004;  Lindsey Enewold aff002;  Noel S. Weiss aff005
Působiště autorů: Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America aff001;  National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America aff002;  Information Management Services, Inc., Calverton, Maryland, United States of America aff003;  Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States of America aff004;  Department of Epidemiology, University of Washington, Seattle, Washington, United states of America aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article



Flexible sigmoidoscopy and colonoscopy are both recommended colorectal cancer screening options, but their relative effectiveness needs clarification. The aim of this study was to compare the effectiveness of colonoscopy and flexible sigmoidoscopy for reduction of colorectal cancer incidence.


We conducted a case-control study within the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Cases were subjects age 70–85 years in the SEER-Medicare database diagnosed with CRC during 2004–2013. Up to 3 controls were matched to each case by birth year, sex, race, and SEER region. Receipt of screening colonoscopy or flexible sigmoidoscopy was ascertained from Medicare claims. Conditional logistic regression models were developed to estimate the odds ratios (ORs) and 95% confidence intervals (CI) for a history of screening in cases vs. controls. We conducted secondary analyses by sex, race, endoscopist characteristics, and with varying timing and duration of the look-back period.


Receipt of screening colonoscopy and sigmoidoscopy was associated with a 59% (OR 0.41, 95%CI 0.39, 0.43) and 22% reduction (OR 0.78, 95%CI 0.67, 0.92) in colorectal cancer incidence, respectively. Colonoscopy was associated with greater reduction in the distal colorectal cancer incidence (OR 0.22, 95%CI 0.20, 0.24) than proximal colorectal cancer incidence (OR 0.62, 95%CI 0.59, 0.66). Sigmoidoscopy was associated with a 52% reduction in distal colorectal cancer incidence (OR 0.48, 95%CI 0.37, 0.63), but with no reduction in proximal colorectal cancer incidence. These associations were stronger in men than in women. No differences by race or endoscopist characteristics were observed.


Both screening colonoscopy and sigmoidoscopy were associated with reductions in overall colorectal cancer incidence, with a greater magnitude of reduction observed with colonoscopy.

Klíčová slova:

Cancer detection and diagnosis – Cancer screening – Colon – Colorectal cancer – Disease surveillance – Endoscopy – Medicare – colonoscopy


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