Flexible sigmoidoscopy saves lives, money, study says

Brian Cox.
Brian Cox.
Fewer New Zealanders will die of bowel cancer if a new screening tool is introduced, new University of Otago research suggests.

Introducing flexible sigmoidoscopy screening into the national bowel screening programme would significantly reduce both the incidence and mortality of bowel cancer in New Zealand, the research, led by Professor Brian Cox, said.

The number of bowel cancer cases prevented would increase over 17 years to more than 300 annually, by 2033.

One bowel cancer would be entirely prevented for about every 78 people screened and one death prevented for about every 203 people screened.

The research also shows one-off flexible sigmoidoscopy screening for people at some time between 50 to 59 years, an age group for which bowel cancer screening is not currently offered, would reduce demand for colonoscopy and also reduce long-term health system costs.

Taking into account the costs of carrying out the procedure and the need for fewer colonoscopies, Professor Cox and his colleagues estimated overall cost savings of $5.4million annually would begin after about 10 years of screening using flexible sigmoidoscopy.

There was very strong randomised controlled trial evidence that carrying out this procedure for people at 55 years of age would be significantly beneficial, Prof Cox said.

Inclusion of flexible sigmoidoscopy screening at 55 years of age would provide a major opportunity for people to reduce their risk of developing or dying of bowel cancer. Mortality from left-sided bowel cancer, the majority of bowel cancer, would be only one-third of current mortality.

Therefore, the addition of flexible sigmoidoscopy screening to the national bowel screening programme would greatly increase the effectiveness of the programme.

The procedure involves a trained medical professional using a flexible, narrow tube with a light and tiny camera on one end to look inside a person’s rectum and lower colon.

The procedure takes about 20 minutes and patients do not have to be sedated, meaning they can return to work, drive or return to home immediately after the procedure.

It was well recognised that nurses could be trained to conduct the procedure and it was estimated only about 18 such screeners would be required to provide the screening in New Zealand, Prof Cox said.

New Zealand has the highest incidence of bowel cancer in the world among women and the sixth highest incidence among men with about 3200 people developing the disease each year and 1250 dying from it annually.

Sigmoidoscopy screening was already provided at the Canterbury Charity Hospital, run largely by volunteer doctors, nurses and administrators and funded entirely through charitable donations.

Canterbury Charity Hospital has shown that a flexible sigmoidoscopy screening programme can be provided in New Zealand to support general practitioners and their patients. This model should be extended to deliver affordable, well-tolerated, safe and effective once-in-a-lifetime screening in New Zealand.


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