In patients without broad-definition anemia and/or abdominal mass, flexible sigmoidoscopy (FS), instead of colonoscopy, may suffice to rule out colorectal cancer, according to a study published online Dec. 19 in the British Journal of Cancer.

Using hospital records and cancer registries, Amanda J. Cross, Ph.D., from Imperial College London, and colleagues followed 7,375 patients (≥55 years) with suspected colorectal cancer who were referred to 21 English hospitals (2004 to 2007). The authors sought to determine which patients could undergo FS instead of colonoscopy.

One hundred twenty-seven proximal and 429 distal colorectal cancers were diagnosed during the study period. The researchers found that a broad anemia definition (<13 g/dL in men and <12 g/dL in women) identified 80 percent of proximal cancers. A narrow definition of anemia (hemoglobin <11 g/dL in men and <10 g/dL in women) with iron-deficiency anemia identified 39 percent of proximal cancers. In patients with broad-definition anemia and/or abdominal mass, the proximal cancer yield was 4.8 percent and number of needed whole-colon examinations (NNE) to diagnose one cancer was 21. In patients without broad-definition anemia and/or abdominal mass but with rectal bleeding or increased stool frequency (41 percent of the cohort), proximal cancer yield was 0.4 percent and NNE was 234.

"In patients without broad definition anemia and/or abdominal mass, with rectal bleeding or increased stool frequency, proximal cancer is rare and FS should suffice," the authors write.

One author disclosed financial ties to PENTAX Medical, Olympus, Fujifilm, and Aquilant.

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