Is there a place for screening flexible sigmoidoscopy?

Flexible sigmoidoscopy is a valid screening tool for the early detection of colorectal cancer (CRC). Recently published long-term data from UKFSST, a randomized controlled trial, demonstrate a 33% reduction in colorectal cancer incidence and a 43% decrease in colorectal cancer mortality, with once-in-a-lifetime screening. On the other hand, data from the NORCCAP trial with a similar protocol show no reduction in CRC incidence and only nonsignificant decrease in CRC mortality at 7 years. At best, flexible sigmoidoscopy can detect only 70% of cancers and polyps as it does not detect the 40% of proximal neoplasms which are not associated with a distal lesion. The advantage of flexible sigmoidoscopy over other screening modalities lies in its safety profile, patient tolerance, and overall acceptance. Its technical simplicity, short duration, and cost-effectiveness advance its applicability to mass screening programs.