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Featured Clinical Reviews

July 28, 2010

Colonoscopy vs Sigmoidoscopy Screening: Getting It Right

Author Affiliations

Author Affiliations: Department of Medicine (Drs Neugut and Lebwohl) and the Herbert Irving Comprehensive Cancer Center (Dr Neugut), College of Physicians and Surgeons, and Department of Epidemiology (Dr Neugut), Mailman School of Public Health, Columbia University, New York, New York.

JAMA. 2010;304(4):461-462. doi:10.1001/jama.2010.1001

The world of cancer screening has been rocked recently by controversy. Long-standing recommendations on screening for breast, cervical, and prostate cancer have all been questioned based on either new data or reanalyses of older data. A similar controversy is also emerging for colorectal cancer screening.

In the 1980s, sigmoidoscopy screening was common despite lack of evidence for its efficacy. In ensuing decades, case-control studies established that sigmoidoscopy was associated with reduced incidence and mortality from left-sided but not right-sided colon malignancies.1,2 The results of a randomized trial of sigmoidoscopy screening reported by Atkin et al3 established the efficacy of sigmoidoscopy in reducing mortality due to colorectal cancer. As in the case-control studies, the randomized trial found that this effect was limited to the distal colon.

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