A Randomized, Controlled Trial to Assess a Novel Colorectal Cancer Screening Strategy: The Conversion Strategy

Stern, Mark A.; Fendrick, A. Mark; McDonnell, W. Michael; Gunaratnam, Naresh; Moseley, Richard; Chey, William D.
August 2000
American Journal of Gastroenterology;Aug2000, Vol. 95 Issue 8, p2074
Academic Journal
OBJECTIVE: Our study was a randomized, controlled trial to assess a novel strategy that provides comprehensive colorectal cancer screening in a single visit versus traditional sigmoidoscopy and, where appropriate, colonoscopy on a subsequent day. METHODS: Consecutive patients referred for screening were randomized to control or so-called "conversion" groups. Patients in the control group were prepared for sigmoidoscopy with oral phospho-soda. Those with an abnormal sigmoidoscopy were scheduled for colonoscopy on a future day after oral polyethylene glycol preparation. In the conversion group, patients were prepared with oral phospho-soda. Patients with a polyp >5 mm or multiple diminutive polyps were converted from sigmoidoscopy to colonoscopy, allowing comprehensive screening in a single visit. Clinical outcomes were assessed by postprocedure physician and patient questionnaires. RESULTS: Two hundred thirty-five patients were randomized (control = 121, conversion = 114). In the control group, 28% had an indication for colonoscopy. Three of 33 (9%) with an abnormal sigmoidoscopy did not return for colonoscopy. At colonoscopy, 27% had a proximal adenoma. In the conversion group, 28% had an abnormal sigmoidoscopy and underwent conversion to colonoscopy. Forty-one percent undergoing colonoscopy in the conversion group had a proximal adenoma. Physicians reported no differences in preparation or procedure difficulty, whereas patients reported no differences in the level of comfort or overall satisfaction between groups. When queried regarding preferences for future screening, 96% chose the conversion strategy. CONCLUSIONS: The conversion strategy led to similar outcomes compared to traditional screening while improving compliance with colonoscopy in patients with an abnormal sigmoidoscopy.


Related Articles

  • Promoting Use of Colorectal Cancer Screening Tests: Can We Change Physician Behavior? Walsh, Judith M. F.; Salazar, René; Terdiman, Jonathan P.; Gildengorin, Ginny; Pérez-Stable, Eliseo J. // JGIM: Journal of General Internal Medicine;Dec2005, Vol. 20 Issue 12, p1097 

    BACKGROUND: Colorectal cancer (CRC) screening is underutilized despite evidence that screening reduces mortality. 0BJECTIVE: To assess the effect of an intervention targeting physicians and their patients on rates of CRC screening. DESIGN: A randomized clinical trial of community physicians and...

  • Once-Only Sigmoidoscopy in Colorectal Cancer Screening: Follow-up Findings of the Italian Randomized Controlled Trial—SCORE. Segnan, Nereo; Armaroli, Paola; Bonelli, Luigina; Risio, Mauro; Sciallero, Stefania; Zappa, Marco; Andreoni, Bruno; Arrigoni, Arrigo; Bisanti, Luigi; Casella, Claudia; Crosta, Cristiano; Falcini, Fabio; Ferrero, Franco; Giacomin, Adriano; Giuliani, Orietta; Santarelli, Alessandra; Visioli, Carmen Beatriz; Zanetti, Roberto; Atkin, Wendy S.; Senore, Carlo // JNCI: Journal of the National Cancer Institute;Sep2011, Vol. 103 Issue 17, p1310 

    Background A single flexible sigmoidoscopy at around the age of 60 years has been proposed as an effective strategy for colorectal cancer (CRC) screening. Methods We conducted a randomized controlled trial to evaluate the effect of flexible sigmoidoscopy screening on CRC incidence and mortality....

  • Screening colonoscopy: Is it time? Simon, Jerome B. // CMAJ: Canadian Medical Association Journal;11/14/2000, Vol. 163 Issue 10, p1277 

    Examines the debate surrounding the health benefits of periodic surveillance colonoscopy. Inadequacy of fecal occult blood testing (FOBT) and sigmoidoscopy for middle-aged and elderly patients at risk for colorectal cancer; Details of a study of the use of colonoscopy in general population...

  • Randomized Trial of Different Screening Strategies for Colorectal Cancer: Patient Response and Detection Rates. Segnan, Nereo; Senore, Carlo; Andreoni, Bruno; Arrigoni, Arrigo; Bisanti, Luigi; Cardelli, Alessandro; Castiglione, Guido; Crosta, Cristiano; DiPlacido, Roberta; Ferrari, Arnaldo; Ferraris, Roberto; Ferrero, Franco; Fracchia, Mario; Gasperoni, Stefano; Malfitana, Giuseppe; Recchia, Serafino; Risio, Mauro; Rizzetto, Mario; Saracco, Giorgio; Spandre, Mauro // JNCI: Journal of the National Cancer Institute;3/2/2005, Vol. 97 Issue 5, p347 

    Background: Although there is general consensus concerning the efficacy of colorectal cancer screening, there is a lack of agreement about which routine screening strategy should be adopted. We compared the participation and detection rates achievable through different strategies of colorectal...

  • Screening for colorectal cancer: implications for UK and European initiatives. Hurlstone, D.; Karajeh, M.; Shorthouse, A. // Techniques in Coloproctology;Nov2004, Vol. 8 Issue 3, p139 

    Colorectal cancer (CRC) is the third most common cancer after lung and prostate cancers, and is the second most common cancer in women in the United Kingdom (UK) after breast cancer. The disease is well suited for prevention with screening programs. CRC is invariably fatal when diagnosed at an...

  • Screening cuts colonoscopies.  // Pulse;3/1/2007, Vol. 67 Issue 8, p16 

    The article reports on a study conducted to 1,124 colorectal cancer patients aged 56-69 to investigate the efficacy of faecal immunochemical tests as a disease detection strategy in Scotland. Such trial implies that detection rates was an efficient and effective disease detection strategy, since...

  • Trends and Determinants of Up-to-date Status with Colorectal Cancer Screening in Tennessee, 2002-2008. Veeranki, Sreenivas P.; Shimin Zheng // International Journal of Preventive Medicine;Jul2014, Vol. 5 Issue 7, p865 

    Background: Screening rates for colorectal cancer (CRC) are increasing nationwide including Tennessee (TN); however, their up-to-date status is unknown. The objective of this study is to determine the trends and characteristics of TN adults who are up-to-date status with CRC screening during...

  • Education Improves Colorectal Cancer Screening by Flexible Sigmoidoscopy in an Inner City Population. Zubarik, Richard; Eisen, Glenn; Zubarik, Jennifer; Teal, Carlotta; Benjamin, Stanley; Glaser, Moshe; Jack, Momudu // American Journal of Gastroenterology;Feb2000, Vol. 95 Issue 2, p509 

    OBJECTIVE: The District of Columbia General Hospital has a flexible sigmoidoscopy (FS) colorectal cancer screening program. We noted that this program was underused. The aim of this study was to determine whether education could improve use of a flexible sigmoidoscopy screening program in an...

  • Colorectal Cancer Screening and Surveillance. SHORT, MATTHEW W.; LAYTON, MILES C.; TEER, BETHANY N.; DOMAGALSKI, JASON E. // American Family Physician;1/15/2015, Vol. 91 Issue 2, p93 

    Colorectal cancer is the third most common cancer in men and women. The incidence and mortality rate of the disease have been declining over the past two decades because of early detection and treatment. Screening in persons at average risk should begin at 50 years of age; the U.S. Preventive...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics