PMID- 22341106
OWN - NLM
STAT- MEDLINE
DCOM- 20120625
LR  - 20120220
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 75
IP  - 3
DP  - 2012 Mar
TI  - Colorectal cancers not detected by screening flexible sigmoidoscopy in the 
      Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.
PG  - 612-20
LID - 10.1016/j.gie.2011.10.024 [doi]
AB  - BACKGROUND AND OBJECTIVE: Diagnosis of colorectal cancer after negative findings 
      on endoscopic evaluation raises concern about the effectiveness of endoscopic 
      screening. We contrast screening-detected cancers with cancers not detected by 
      screening among participants assigned to flexible sigmoidoscopy (FSG) in the 
      Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial to 
      determine the reasons for the lack of detection of prevalent lesions. DESIGN: 
      Cancers detected within 1 year of a screening FSG with abnormal findings were 
      classified as screening detected. All other cancers were categorized, based on 
      cancer stage and years until detection, as either not detectable or prevalent but 
      not detected at the time of screening. SETTING/PATIENTS: A total of 77,447 
      subjects in the multicenter PLCO trial. MAIN OUTCOME MEASUREMENTS: A total of 977 
      colorectal cancers were diagnosed with a mean follow-up of 11.5 years. RESULTS: A 
      total of 243 (24.9%) cancers were screening detected, 470 (48.1%) were not 
      detectable at screening, and 264 (27.0%) were considered prevalent but not 
      detected. Among prevalent nondetected lesions, 35.6% (n = 94) were attributed to 
      problems in patient compliance (58 never screened, 34 delayed colonoscopy 
      follow-up, and 2 inadequate bowel preparation), 43.9% (n = 116) were attributable 
      to a limitation in the FSG procedure (97 beyond the reach of the sigmoidoscope 
      and 19 inadequate depth of insertion on FSG), and 20.5% (n = 54) were caused by 
      endoscopist limitation (33 missed on FSG, 21 missed at initial colonoscopy) (P < 
      .0001). Had colonoscopy instead of FSG been used for screening, an additional 
      15.6% and as many as 19.0% of cancers may have been screening-detected. 
      LIMITATIONS: These estimates are reasonable approximations, but biological 
      variability precludes precise determinations. CONCLUSIONS: Prevalent nondetected 
      cancers were more often attributable to problems with patient compliance or 
      limitations in the FSG procedure than to missed lesions. Colonoscopy instead of 
      FSG could have moderately increased the detection of cancer via screening.
CI  - Copyright (c) 2012 American Society for Gastrointestinal Endoscopy. Published by 
      Mosby, Inc. All rights reserved.
FAU - Schoen, Robert E
AU  - Schoen RE
AD  - Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, 
      Pennsylvania, USA. rschoen@pitt.edu
FAU - Pinsky, Paul F
AU  - Pinsky PF
FAU - Weissfeld, Joel L
AU  - Weissfeld JL
FAU - Yokochi, Lance A
AU  - Yokochi LA
FAU - Church, Timothy
AU  - Church T
FAU - Laiyemo, Adeyinka O
AU  - Laiyemo AO
FAU - Bresalier, Robert
AU  - Bresalier R
FAU - Hickey, Tom
AU  - Hickey T
FAU - Riley, Thomas
AU  - Riley T
FAU - Prorok, Philip C
AU  - Prorok PC
LA  - eng
GR  - N01-CN-25511/CN/NCI NIH HHS/United States
GR  - N01-CN-25513/CN/NCI NIH HHS/United States
GR  - N01-CN-25515/CN/NCI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - Aged
MH  - Colonoscopy
MH  - Colorectal Neoplasms/*pathology
MH  - False Negative Reactions
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Sigmoidoscopy/*methods
EDAT- 2012/02/22 06:00
MHDA- 2012/06/26 06:00
CRDT- 2012/02/21 06:00
PHST- 2011/08/08 00:00 [received]
PHST- 2011/10/19 00:00 [accepted]
PHST- 2012/02/21 06:00 [entrez]
PHST- 2012/02/22 06:00 [pubmed]
PHST- 2012/06/26 06:00 [medline]
AID - S0016-5107(11)02335-2 [pii]
AID - 10.1016/j.gie.2011.10.024 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2012 Mar;75(3):612-20. doi: 10.1016/j.gie.2011.10.024.