Original articleAlimentary tractDiagnostic Yield of One-Time Colonoscopy vs One-Time Flexible Sigmoidoscopy vs Multiple Rounds of Mailed Fecal Immunohistochemical Tests in Colorectal Cancer Screening
Section snippets
Study Population and Design
For the purpose of this study we combined results of 3 population trials, each comprising randomly selected, screening-naive persons. At the start of these trials there had been no previous CRC screening trials in The Netherlands or any screening programs. The design of these trials has been described previously and can be found in the Supplementary Methods.17, 18, 19
Interventions
All invitees received an advance notification letter, followed by a kit 2 weeks later by postal mail; all of these were sent from
Screening Population, Participation, and Colonoscopy Rates
A total of 30,052 average-risk persons were invited. Median age was similar for all 3 screening groups: 59 years for FIT (interquartile range [IQR], 55–65 years), 59 years for FS (IQR, 54–65), and 60 years for colonoscopy (IQR, 54–65). There were no gender differences, with 50% (n = 14,328) of the invitees being male (FIT, n = 7264 [50%]; FS, n = 3941 [50%]; and colonoscopy, n = 2982 [50%]). An overview of the study design, participation rates, and adherence to diagnostic follow-up is provided
Discussion
This analysis comparing one-time colonoscopy with one-time sigmoidoscopy with 4 rounds of mailed FITs indicates a higher diagnostic yield of AN among invitees in FIT screening compared with endoscopic screening. This yield was reached with significantly fewer colonoscopies for FIT screening and FS screening than colonoscopy screening. No differences were found regarding the detection of CRC between all 3 strategies. Between participants, colonoscopy had the highest diagnostic yield for AN,
Acknowledgments
The authors thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the Netherlands Cancer Registry as well as IKNL staff for scientific advice. The authors thank the Netherlands Organization for Health Research and Development of the Dutch Ministry of Health (ZonMW) for funding. The authors thank all involved coworkers of the Foundation of Population Screening Mid-West and South-West (Bevolkingsonderzoek MiddenWest,
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2022, The Lancet Regional Health - EuropeCitation Excerpt :However, such single invitation letters every 5 years, which are accompanied by lengthy (>20 pages) and highly technical information brochures, are unlikely to achieve any relevant increase in use of screening offers, particularly among less educated high-risk groups. There is meanwhile overwhelming evidence, both from randomized clinical trials and real life experience from multiple countries, that well-organized screening programs that combine effective, easy to understand communication of screening offers with low-threshold access to screening may strongly increase adherence to effective screening offers.42–45 Taking this evidence into account, policymakers should engage to carefully revise the current offers and invitation schemes of the German early cancer detection program for CRC.
Effectiveness and Harms of Colorectal Cancer Screening Strategies
2022, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :Table 1 provides a comparison of the various screening tests. In a Dutch study comparing the diagnostic yield of one-time colonoscopy to 4 rounds of mailed FIT, the cumulative participation rate was higher for FIT (73%) than colonoscopy (24%).47 In the intention-to-treat analysis, the cumulative diagnostic yield of advanced neoplasia was higher for FIT than colonoscopy (4.5% vs 2.2%), highlighting the importance of the participation rate on a population level.
Colorectal Cancer Screening With Repeated Fecal Immunochemical Test Versus Sigmoidoscopy: Baseline Results From a Randomized Trial
2021, GastroenterologyCitation Excerpt :No randomized trial comparing the effectiveness of repeated FIT with sigmoidoscopy screening on CRC mortality and incidence currently exists. Previous studies comparing detection rates of FIT vs sigmoidoscopy screening included only 1 FIT round, were nonrandomized, had small sample sizes, or had poor participation rates in the sigmoidoscopy arm (28.1%–32.4%).23–26 One of the trials, combining results from 3 Dutch screening cohorts, found higher detection rates for advanced neoplasia and CRC with 4 rounds of FIT compared to sigmoidoscopy.24
Conflicts of interests The authors disclose no conflicts.
Funding Supported by The Netherlands Organization for Health Research and Development (ZonMW20034001, ZonMW 120720012, ZonMW120710007, ZonMW63000004, and ZonMW12010095420).
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Authors contributed equally and share co-first authorship.