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Colonoscopy has largely supplanted other approaches to colorectal cancer (CRC) screening in the U.S. However, sigmoidoscopy should not be dismissed out of hand: Compared with colonoscopy, preparation for sigmoidoscopy is easier, and complications are fewer. In a randomized trial from Italy, 17,000 people (age range, 55–64) were offered flexible sigmoidoscopy screening, and 17,000 served as controls; 9900 (58%) of those invited to screening actually underwent sigmoidoscopy. People with single high-risk adenomas or multiple adenomas of any type were referred for colonoscopy. Median follow-up was 11 years.
In an intent-to-treat analysis, CRC mortality was about 44 per 10,000 among controls and 35 per 10,000 among people assigned to screening — …