Sigmoidoscopy: a shortcut to effective screening or a dead end?
Mené aux Etats-Unis auprès de 3 222 participants (âge : de 55 à 74 ans ; durée médiane de suivi : 15,8 ans), cet essai évalue l'effet d'un dépistage du cancer colorectal par sigmoïdoscopie flexible sur l'incidence de la maladie et la mortalité spécifique
Three established methods for colorectal cancer screening exist: faecal occult blood testing (FOBT), colonoscopy, and sigmoidoscopy. Screening sigmoidoscopy has been proven to reduce both colorectal cancer incidence and mortality in four large randomised controlled trials. By contrast, two other screening methods have much weaker evidence for effectiveness. An old fashioned guaiac FOBT test has been proven in randomised trials to reduce colorectal cancer mortality only. The modern and widely endorsed immunochemical FOBT test is considered more effective, also in terms of colorectal cancer incidence reduction, but the evidence to prove it will not be available for several years. The evidence for effectiveness of screening colonoscopy comes from observational studies and extrapolation of sigmoidoscopy trial results. The results of randomised trials of screening colonoscopy are awaited, but also will not be available for several years.
The Lancet Gastroenterology & Hepatology , commentaire, 2017