Evidence map›Paper›PMID 28236467›Full record

Trial reportLancet (London, England)2017

Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: the UK Flexible Sigmoidoscopy Screening randomised controlled trial.

Wendy Atkin, Kate Wooldrage, D Maxwell Parkin, Ines Kralj-Hans, Eilidh MacRae, Urvi Shah, Stephen Duffy, Amanda J Cross

Open access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Lancet (London, England), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 153 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
153citing papers in PubMed, 11 pooled it
18.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

153 citing papers in PubMed, 11 syntheses or guidelines pooled it, 370 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Guideline
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Trial
  13. Trial
  14. Trial
  15. Trial
  16. Higher Adenoma Detection Rates at Screening Associated With Lower Long-Term Colorectal Cancer Incidence and Mortality.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2022
    Trial
  17. Trial
  18. Validation of Colorectal Cancer Models on Long-term Outcomes from a Randomized Controlled Trial.Medical decision making : an international journal of the Society for Medical Decision Making · 2020
    Trial
  19. Trial
  20. Trial

93 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Wendy AtkinCancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK. Electronic address: w.atkin@imperial.ac.uk.
Kate WooldrageCancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
D Maxwell ParkinClinical Trial Service Unit, The Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK.
Ines Kralj-HansCancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
Eilidh MacRaeCancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
Urvi ShahCancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
Stephen DuffyCentre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, UK.
Amanda J CrossCancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
Imperial College London · GBQueen Mary University of London · GBUniversity of Oxford · GB

Funding

Cancer Research UK 16894Department of Health HTA/16/65/01Medical Research Council G9615910
6 · The paper itself

Abstract

backgroundColorectal cancer is the third most common cancer worldwide. Previous analyses have only reported follow-up after flexible sigmoidoscopy for a maximum of 12 years. We aimed to examine colorectal cancer incidence and mortality after a single flexible sigmoidoscopy screening and 17 years of follow-up.

methodsIn this multicentre randomised trial (UK Flexible Sigmoidoscopy Screening Trial), done between Nov 14, 1994, and March 30, 1999, 170 432 eligible men and women, who had indicated on a previous questionnaire that they would probably attend screening if invited, were randomly assigned (1:2) to an intervention group (offered flexible sigmoidoscopy screening) or a control group (not contacted). Randomisation was done centrally in blocks of 12, and stratified by trial centre, general practice, and household type. The nature of the intervention did not allow the staff to be masked to arm of the trial; however, randomisation was done in batches so that the control group and participants not yet randomised were unaware of their allocation status. The primary outcomes were incidence and mortality of colorectal cancer. Hazard ratios (HRs) and 95% CIs for colorectal cancer incidence and mortality were estimated for intention-to-treat and per-protocol analyses. The trial is registered with ISRCTN, number 28352761.

findingsOur cohort analysis included 170 034 people: 112 936 in the control group and 57 098 in the intervention group, 40 621 (71%) of whom were screened and 16 477 (29%) were not screened. During screening and a median of 17·1 years' follow-up, colorectal cancer was diagnosed in 1230 individuals in the intervention group and 3253 in the control group, and 353 individuals in the intervention group versus 996 individuals in the control group died from colorectal cancer. In intention-to-treat analyses, colorectal cancer incidence was reduced by 26% (HR 0·74 [95% CI 0·70-0·80]; p<0·0001) in the intervention group versus the control group and colorectal cancer mortality was reduced by 30% (0·70 [0·62-0·79]; p<0·0001) in the intervention group versus the control group. In per-protocol analyses, adjusted for non-compliance, colorectal cancer incidence and mortality were 35% (HR 0·65 [95% CI 0·59-0·71]) and 41% (0·59 [0·49-0·70]) lower in the screened group.

interpretationA single flexible sigmoidoscopy continues to provide substantial protection from colorectal cancer diagnosis and death, with protection lasting at least 17 years.

fundingNational Institute for Health Research Efficacy and Mechanism Evaluation.

Indexed as

SigmoidoscopyColorectal NeoplasmsEarly Detection of CancerFemaleFollow-Up StudiesHumansIncidenceMaleMass ScreeningMiddle AgedTime FactorsUnited Kingdom

Identifiers

PMID28236467
PMCPMC6168937
OpenAlexW2590454024

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.