24 Sep

What were the results of the study and what impact have they had?

When the first results of the UKFSST were analysed in 2010, they showed that people who were screened just once with flexible sigmoidoscopy (also known as bowel-scope) were:

  • less likely to get bowel cancer – it prevented about one in three new cases of bowel cancer;
  • less likely to die from the disease – it prevented four in every 10 deaths from bowel cancer.

The protective effects of the once-only flexible sigmoidoscopy also appeared to be long lasting. The UKFSST results were published in The Lancet in 2010.

Because the UKFSST demonstrated that flexible sigmoidoscopy screening can prevent bowel cancer from developing, this suggested that offering a once-only flexible sigmoidoscopy (bowel-scope) screening test to people in the UK should reduce the numbers of people getting bowel cancer and dying from this disease. In 2010, the UK government announced a £60 million investment to introduce bowel-scope screening as part of the English NHS Bowel Cancer Screening Programme. Roll-out of bowel-scope screening began in 2013 and is expected to cover the entire population by 2018. It has been estimated that bowel-scope screening could prevent up to 5,000 people from getting bowel cancer and up to 3,000 deaths from the disease in the UK each year. It is hoped that cancer of the rectum, the lowest part of the bowel examined, could one day become a rare disease.

The results of a further 7 years of follow-up were published in The Lancet in Feb 2017 and show that a single flexible sigmoidoscopy continues to provide substantial protection from bowel cancer diagnosis and death, with protection lasting at least 17 years. News articles were also published by Cancer Research UK and by Imperial College London.

In  addition to the original study objectives, the UKFSST study team has identified the following potential questions  which could be addressed by further analysis of the UKFSST dataset. These analyses will be conducted by the CSPRG medical statisticians and published in peer reviewed journals. No additional data will be requested to meet these objectives.

  • Does the quality of flexible sigmoidoscopy screening affect the future risk of getting bowel cancer and dying from this disease?
  • Does patient experience and procedural factors affect the performance of flexible sigmoidoscopy screening?
  • How safe and acceptable is a once-only flexible sigmoidoscopy?
  • How does having a family history of bowel cancer effect the risk of developing this disease after screening?
  • Can the severity of disease at diagnosis be used to determine the risk of dying from bowel cancer?
  • Among patients identified as higher-risk at their flexible sigmoidoscopy screening, how effective is repeated colonoscopy (examination of the entire bowel) at routine intervals?
  • How commonly does bowel cancer in the upper part of the bowel develop after flexible sigmoidoscopy, and can this be predicted by the number and type of polyp detected at flexible sigmoidoscopy?
  • Does smoking history affect the risk of developing polyps and bowel cancer?
  • Can various medications affect the risk of developing polyps and bowel cancer?
  • Among patients taking part in the UKFSST and also invited to take part in the National Bowel Cancer Screening Programme (BCSP), for which they complete Faecal Occult Blood Tests (FOBTs), how do these two screening tests affect the risk of getting bowel cancer?
  • Can prior flexible sigmoidoscopy affect participation and outcomes of FOBTs in the BCSP?

Publications

Pinsky PF*, Loberg M, Senore C, Wooldrage K, Atkin W, Bretthauer M, Cross AJ, Hoff G, Holme O, Kalager M, Segnan N, Schoen RE. Number of Adenomas Removed and Colorectal Cancers Prevented in Randomized Trials of Flexible Sigmoidoscopy Screening. Gastroenterology. 2018 Jun 20. pii: S0016-5085(18)34667-5. doi: 10.1053/j.gastro.2018.06.040.

Brown JP*, Wooldrage K, Kralj-Hans I, Wright S, Cross AJ, Atkin WS. Effect of once-only flexible sigmoidoscopy screening on the outcomes of subsequent faecal occult blood test screening. J Med Screen. 2018 Oct 3:969141318785654. doi: 10.1177/0969141318785654.

Atkin W, Wooldrage K, Parkin DM, et al. Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: the UK Flexible Sigmoidoscopy Screening randomised controlled trial. Lancet. 2017 Apr 1; 389 (10076): 1299-1311.

McGregor LM, Bonello B, Kerrison RS, et al. Uptake of Bowel Scope (Flexible Sigmoidoscopy) Screening in the English National Programme: the first 14 months. J Med Screen. 2016 Jun;23(2):77-82.

Robb KA, Lo SH, Power E, et al. Patient-reported outcomes following flexible sigmoidoscopy screening for colorectal cancer in a demonstration screening programme in the UK. J Med Screen 2013: 1–6.

Robb K, Power E, Kralj-Hans I, et al. Flexible sigmoidoscopy screening for colorectal cancer: Uptake in a population-based pilot programme. Journal of Medical Screening. 2010;17(2):75-8.

Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet. 2010; 375: 1624–33.

Austin KL, Power E, Solarin I, et al.  Perceived barriers to flexible sigmoidoscopy screening for colorectal cancer among UK ethnic minority groups: a qualitative study. J Med Screen 2009; 16: 174–179.

Miles A, Atkin WS, Kralj-Hans I, et al. The psychological impact of being offered surveillance colonoscopy following attendance at colorectal screening using flexible sigmoidoscopy. J Med Screen 2009; 16(3): 124-130.

Robb KA, Power E, Atkin W, et al. Ethnic differences in participation in flexible sigmoidoscopy screening in the UK.  J Med Screen 2008; 15: 130-136.

Thompson MR, Flashman KG, Wooldrage K, et al. Flexible sigmoidoscopy and whole colonic imaging in the diagnosis of cancer in patients with colorectal symptoms. Br J Surg. 2008; 95: 1140-1146.

Brotherstone H, Vance M, Edwards R, et al. Uptake of population based flexible sigmoidoscopy screening: a nurse-led feasibility study.  J Med Screen 2007;14:76-80.

Mitrou PN, Loktionov A, Atkin W, et al. MTHFR C677T and A1298C polymorphisms and risk of colorectal adenoma in the UK Flexible Sigmoidoscopy Trial. (United Kingdom). Cancer causes control. 2006 Aug;17(6):793-801.

Thomas-Gibson S, Rogers, PA, Cooper S, et al. Judgement of quality of bowel preparation at screening flexible sigmoidoscopy is associated with variability in adenoma detection rates. Endoscopy. 2006;38:456-60.

Gunter MJ, Watson MA, Loktionov AS, et al. No association between cytochrome P450 and Glutathione S-Transferase gene polymorphisms and risk of colorectal adenoma: results from the UK flexible sigmoidoscopy screening trial. Cancer Epidemiology Biomarkers Prev. 2005;14(4):1028-30.

Atkin WS, Rogers P, Cardwell C, et al. Wide variation in adenoma detection rates at screening flexible sigmoidoscopy. Gastroenterology 2004;126:1247-56.

Miles A, Wardle J, Atkin W. Receiving a screen-detected diagnosis of cancer: the experience of participants in the UK flexible sigmoidoscopy trial. Psycho Oncology. 2003;12:784-802.

Adams C, Atkin WS, Cardwell C, et al. Effect of hysterectomy status on polyp detection rates at screening flexible sigmoidoscopy. Gastrointest Endosc. 2003;57(7):848-53.

Whynes DK,Frew EJ, Atkin WS. The costs of flexible sigmoidoscopy screening for colorectal cancer. Int J Technol  Assess Health Care. 2003;19(2):384-95.

Atkin WS, Cook C, Cuzick J, et al. Single flexible sigmoidoscopy screening to prevent colorectal cancer; baseline findings of a UK multicentre randomised trial. Lancet. 2002;359:1291-300.

Atkin WS, Edwards R, Wardle J, et al. Design of a multicentre randomised trial to evaluate flexible sigmoidoscopy in colorectal cancer screening. J Med Screen. 2001; 8:137-44.

McCaffery K, Borrill J, Williamson S, et al. Declining the offer of flexible sigmoidoscopy screening for bowel cancer: a qualitative investigation of the decision-making process. Soc Sci Med. 2001;53:679-91.

Wardle J, Sutton S, Williamson S, et al. Psychosocial influences on older adults interest in participating in bowel cancer screening. Prev Med. 2000;31:323-34.

Sutton S, Wardle J, Taylor T, et al. Predictors of attendance in the UK flexible sigmoidoscopy screening trial. J Med Screen. 2000;7:99-104.

Martin JP, Sexton BF, Saunders BP, et al. Inhaled patient-administered nitrous oxide/oxygen mixture does not impair driving ability when used as analgesia during screening flexible sigmoidoscopy. Gastrointest Endosc. 2000;51:701-3.

Taylor T, Williamson S, Wardle J, et al.  Acceptability of flexible sigmoidoscopy screening in older adults in the UK. J Med Screen. 2000;7:38-45.

Atkin WS, Hart A, Edwards R, et al. Single blind, randomised trial of efficacy and acceptability of oral picolax versus self-administered phosphate enema in bowel preparation for flexible sigmoidoscopy screening. Br Med J. 2000;320:1504-9.

Bell GD, Atkin WS, Painter J, et al. Increasing the reach of flexible sigmoidoscopy. Endoscopy. 1999;31:835.

Frew E, Wolstenholme JL, Atkin WS, et al. Estimating time and travel costs incurred in clinic-based screening: flexible sigmoidoscopy screening for colorectal cancer. J Med Screen. 1999;6:119-23.

Wardle J, Taylor T, Sutton S, et al. Does publicity about cancer screening raise fear of cancer? Randomised trial of the psychological effect of information about cancer screening.  Br Med J. 1999;319:1037-8.

Hart AR, Kudo S, Mackay EH, et al. Flat adenomas exist in asymptomatic people: important implications for colorectal cancer screening programmes. Gut. 1998;43:229-31.

Atkin WS, Hart A, Edwards R, et al. Uptake, yield of neoplasia and adverse effects of flexible sigmoidoscopy. Gut. 1998;42:560-5.

Atkin W. Flexible sigmoidoscopy as a mass screening tool. Euro J Gastroenterol Hepatol. 1998;10:219-23.