Flexible Sigmoidoscopy in the Randomized Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial: Added Yield from a Second Screening Examination
Year: 2012
Type: article
Abstract: BACKGROUND: Among randomized trials evaluating flexible sigmoidoscopy (FSG) for its effect on colorectal cancer mortality, only the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial screened its participants more than one time. We report outcomes from the PLCO screening FSG program and evaluate the increased yield produced by a second FSG. METHODS: Participants were screened by 60-cm FSG in 10 regional screening centers at study entry and 3 or 5 years later, depending on the time of random assignment. Results from subsequent diagnostic intervention were tracked and recorded in a standardized fashion, and outcomes were compared according to sex and age. The protocol discouraged repeat FSG in persons with colorectal cancer or adenoma diagnosed after the initial FSG. RESULTS: Of 77 447 enrollees, 67 073 (86.6%) had at least one FSG and 39 443 (50.9%) had two FSGs. Diagnostic intervention occurred in 74.9% after a positive first FSG and in 78.7% after a positive repeat FSG. The second FSG increased the screening yield by 32%: Colorectal cancer or advanced adenoma was detected in 37.8 per 1000 persons after first screening and in 49.8 per 1000 persons after all screenings. The second FSG increased the yield of cancer or advanced adenoma by 26% in women and by 34% in men. Of 223 subjects who received a diagnosis of colorectal carcinoma within 1 year of a positive FSG, 64.6% had stage I and 17.5% had stage II disease. CONCLUSIONS: Repeat FSG increased the detection of colorectal cancer or advanced adenoma in women by one-fourth and in men by one-third. Screen-detected carcinomas were early stage (stage I or II) in greater than 80% of screened persons. Colorectal cancer mortality data from the PLCO, as the definitive endpoint, will follow in later publications.
DOI: 10.1093/jnci/djr549
Authors: J. L. Weissfeld, R. E. Schoen, P. F. Pinsky, R. S. Bresalier, V. P. Doria-Rose, A. O. Laiyemo, T. Church, L. A. Yokochi, S. Yurgalevitch, J. Rathmell, G. L. Andriole, S. Buys, E. D. Crawford, M. Fouad, C. Isaacs, L. Lamerato, D. Reding, P. C. Prorok, C. D. Berg, for the PLCO Project Team
Institutions: University of Pittsburgh, UPMC Health System, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, National Institutes of Health, University of Minnesota, Washington University in St. Louis, University of Utah, Henry Ford Hospital, National Cancer Institute, University of Colorado Denver, The University of Texas MD Anderson Cancer Center, Westat (United States), Information Management Services, University of Alabama, Georgetown University, Henry Ford Health, Marshfield Clinic, Marshfield Clinic, Marshfield Clinic
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: PROSTATE, LUNG, COLORECTAL &OVARIAN (PLCO) CANCER, G1129713815, PROSTATE, LUNG, COLORECTAL AND OVARIAN CANCER, PROSTATE, LUNG, COLORECTAL AND OVARIAN (PLCO) CANCER, G1285883624, G142049768, G1578565442, PROSTATE, LUNG, COLORECTAL, AND OVARIAN (PLCO) CANCER, PROSTATE, LUNG, COLORECTAL AND OVARIAN (PLCO) CANCER, G2070044820, G2250436683, PROSTATE, LUNG, COLORECTAL AND OVARIAN (PLCO) CANCER, PROSTATE, LUNG, COLORECTAL AND OVARIAN (PLCO) CANCER, PROSTATE, LUNG, COLORECTAL AND OVARIAN (PLCO) CANCER, PROSTATE, LUNG, COLORECTAL, &OVARIAN CANCER SCREENING, PROSTATE, LUNG, COLORECTAL &OVARIAN CANCER, PROSTATE, LUNG, COLORECTAL AND OVARIAN CANCER, PROSTATE, LUNG, COLORECTAL AND OVARIAN (PLCO) CANCER, G4922896994, G668214460, G840131496, G957887912, G979407967, G996329585
OpenAlex ID: W2103307481