Colonoscopy is widely embraced as the gold standard of colorectal cancer screening, but it is one of many tests designed to detect CRC. A recent study published in The Journal of the AmericanMedical Association examines the effects of flexible sigmoidoscopy on CRC incidence and mortality in Norway.
Gastroenterologist William Katkov, MD, answers questions about the study and considers its implications for CRC screening in the United States.
Q: Why is this study important for the field of gastroenterology?
William Katkov, MD, Providence Saint John's Health Center, Santa Monica, Calif.: This study is important because it is a well-designed clinical trial that once again demonstrates that effective screening prevents both the development of colon cancer and deaths due to colon cancer. Similar trials have been undertaken with colonoscopy and arrived at the same conclusions. However, this trial is not saying that sigmoidoscopy is equivalent to colonoscopy. It simply demonstrates that sigmoidoscopy is one effective screening tool. The question of whether sigmoidoscopy is, in and of itself, a sufficient screening modality would require a direct head-to-head comparison with colonoscopy.
Q: Do you think sigmoidoscopy has a role to play in colorectal cancer screening in the United States?
WK: The appeal of sigmoidoscopy is that it requires a less vigorous preparation. It can be performed in an office setting without sedation. It does not require the same equipment and monitoring as an ambulatory endoscopy center or hospital GI unit. However, sigmoidoscopy can be a very uncomfortable procedure. The message remains that screening is effective and any screening is better than no screening.
Q: As new colon cancer screening tools continue to roll out, do you think tests like sigmoidoscopy will become obsolete?
WK: I think sigmoidoscopy and colonoscopy will take on new roles as technological advances continue and new screening tools emerge. There is often an assumption that existing technologies will inevitably become obsolete. To the contrary, new screening tools may, in the end, increase the volume of colonoscopies. As a greater proportion of the population is screened, the role of colonoscopy may shift from its predominant use as a screening modality to an effective diagnostic tool. New screening and diagnostic tests must be carefully evaluated to insure that high rates of false positive results do not lead to unnecessary diagnostic testing.
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