Colonoscopy Alternative Reduces Cancer Rates, Research Finds

An alternative to colonoscopy that only looks at a portion of the colon rather than the whole intestine reduced cancer rates, a study found.

The screening, called flexible sigmoidoscopy, was associated with a 21 percent decline in colon cancer cases and a 26 percent reduction in deaths from the disease compared with those given usual care, according to research presented today at Digestive Disease Week in San Diego and published in the New England Journal of Medicine. Many of those who had an abnormal result with sigmoidoscopy then had a colonoscopy.

More than 103,000 new cases of colon cancer will be diagnosed this year and about 50,000 people die from the disease in the U.S., according to the National Cancer Institute. About 40 percent of the U.S. population that should be screened aren’t getting the procedure, lead study author Robert Schoen said. Preparation for flexible sigmoidoscopy takes less time, and offering an alternative may help reduce colon cancer, he said.

“It is an expensive test and some people don’t want to have it, so we need to use alternative tests,” said Schoen, a professor of medicine and epidemiology at the University of Pittsburgh, in a telephone interview today.

A patient undergoing a flexible sigmoidoscopy doesn’t need to be sedated for the procedure. The procedure usually only requires a couple of enemas on the day of the test. A standard colonoscopy on the other hand involves taking a laxative with as much as a gallon of liquid the day before the procedure. During a colonoscopy, patients are sedated while a fiberoptic tube with a camera and light are inserted into the intestine.

Study Design

The study, which started in 1993, included 154,900 men and women who were ages 55 to 74. Participants were randomly assigned to receive flexible sigmoidoscopy with repeat screening at three or five years or usual care, which was whatever screening they received during routine medical care under their physician.

The researchers found 1,012 cases of colon cancer in the treatment group compared with 1,287 in the usual care group, a 21 percent reduction. There were 252 deaths in the treatment group and 341 in the usual care group, a 26 percent reduction.

The study also showed a 50 percent reduction in death from distal colon cancer, which is a portion of the colon examined by flexible sigmoidoscopy.

About 22 percent in the flexible sigmoidoscopy group who had an abnormal result went on to have a full colonoscopy within one year of the abnormal result, Schoen said.

The study was funded by the U.S. National Cancer Institute, part of the National Institutes of Health.

To contact the reporter on this story: Nicole Ostrow in New York at

To contact the editor responsible for this story: Reg Gale at

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