SCREENING SIGMOIDOSCOPY AND COLORECTAL-CANCER MORTALITY
SCREENING SIGMOIDOSCOPY AND COLORECTAL-CANCER MORTALITY
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DOI：
10.1093/jnci/84.20.1572
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发表时间：
1992-10-21
影响因子：
10.3
通讯作者：
MARCUS, PM
中科院分区：
文献类型：
--
作者：
NEWCOMB, PA;NORFLEET, RG;MARCUS, PM
背景资料：乙状结肠镜检查可以通过识别癌症和前驱病变（包括息肉）来降低结直肠癌的死亡率;然而，关于这种技术作为筛查程序的有效性的证据非常有限。目的：在缺乏随机对照试验数据的情况下，我们进行了一项回顾性病例对照研究，以确定乙状结肠镜检查筛查是否与结直肠癌死亡率降低相关。研究方法：回顾了1979年至1988年死于大肠癌的66名大沼泽地社区卫生计划（GMCHP）成员的病历，以了解结直肠癌筛查史（病例受试者）。为了进行比较，随机选择了196名性别、年龄和入组时间相似的GMCHP成员的记录进行审查（对照组）。结果：乙状结肠镜检查的筛查史在病例组（10%）比对照组（30%）少得多。与从未接受过乙状结肠镜检查的人相比，接受过乙状结肠镜检查的人结直肠癌死亡风险降低（比值比= 0.21; 95%置信区间= 0.08-0.52）。风险的降低似乎仅限于直肠和远端结肠的肿瘤。粪便潜血试验和直肠指检均与结直肠癌死亡率降低无关。结论：这些结果表明，乙状结肠镜检查可以显著降低直肠癌和远端结肠癌的死亡率。
Background: Sigmoidoscopy may reduce colorectal cancer mortality by identifying both cancers and precursor lesions (including polyps) for treatment; however, evidence regarding the efficacy of this technique as a screening procedure is extremely limited. Purpose: In the absence of data from randomized controlled trials, we performed a retrospective case-control study to determine if sigmoidoscopy screening is associated with a reduction in colorectal cancer mortality. Methods: The medical records of 66 members of the Greater Marshfield Community Health Plan (GMCHP) who died of large-bowel cancer from 1979 to 1988 were reviewed for history of screening for colorectal cancer (case subjects). For comparison, the records of 196 GMCHP members of similar gender, age, and enrollment duration were randomly selected for review (control subjects). Results: History of screening sigmoidoscopy was much less common among case subjects (10%) than among control subjects (30%). Risk for death from colorectal cancer was reduced among individuals having had a single examination by screening sigmoidoscopy (odds ratio = 0.21; 95% confidence interval = 0.08-0.52), compared with the risk for those who never had one. The reduction in risk appeared to be limited to tumors in the rectum and distal colon. Neither fecal occult blood testing nor digital rectal examination was associated with a reduction in colorectal cancer mortality. Conclusions: These results suggest that screening sigmoidoscopy can substantially reduce mortality from cancers of the rectum and distal colon.