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@ARTICLE{Niedermaier:134862,
      author       = {T. Niedermaier$^*$ and K. Weigl$^*$ and M. Hoffmeister$^*$
                      and H. Brenner$^*$},
      title        = {{F}lexible sigmoidoscopy in colorectal cancer screening:
                      implications of different colonoscopy referral strategies.},
      journal      = {European journal of epidemiology},
      volume       = {33},
      number       = {5},
      issn         = {1573-7284},
      address      = {Dordrecht [u.a.]},
      publisher    = {Springer Science + Business Media B.V.},
      reportid     = {DKFZ-2018-00652},
      pages        = {473 - 484},
      year         = {2018},
      abstract     = {Flexible sigmoidoscopy (FS) screening reduces colorectal
                      cancer incidence and mortality. Its potential to detect
                      proximal neoplasms depends on colonoscopy referral. We
                      estimated diagnostic performance of sigmoidoscopy using 12
                      different referral criteria in detecting colorectal cancer
                      and advanced adenomas. Colonoscopy results from 14,947
                      participants of screening colonoscopy in Germany were used
                      to derive sensitivity of sigmoidoscopy for colorectal
                      cancer, advanced adenomas (AAs), and any advanced neoplasms
                      in the proximal colon. It was assumed that FS detects the
                      same neoplasms as colonoscopy within its reach and that
                      distal neoplasms would be followed by colonoscopy. In
                      addition, numbers of colonoscopies needed (NCN) to detect
                      one proximal advanced neoplasm were calculated. The most
                      advanced findings during colonoscopy were colorectal cancer
                      in 213 subjects $(1.4\%),$ AA in 1539 subjects $(10.2\%)$
                      and non-advanced adenomas in 2988 subjects $(19.8\%).$
                      Without colonoscopy referral, overall sensitivities for any
                      colorectal cancer, advanced adenoma and any advanced
                      neoplasm (proximal or distal) would be 79, 65 and $66\%,$
                      respectively. These sensitivities could be increased to up
                      to 86, 83 and $84\%$ by the referral strategies
                      investigated. Compared to referral due to advanced adenomas,
                      referral due to non-advanced adenomas would substantially
                      increase the NCN at a modest gain in sensitivity.
                      Sensitivities were higher and NCNs were lower in men than in
                      women for every strategy. In conclusion, colonoscopy
                      referral can substantially increase sensitivity of
                      sigmoidoscopy-based screening, but the gain by referral due
                      to non-advanced adenomas substantially increases NCN
                      compared to referral due to advanced neoplasms only. Major
                      sex differences may call for sex-specific referral
                      strategies.},
      cin          = {C070 / G110 / L101},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)G110-20160331 /
                      I:(DE-He78)L101-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:29752577},
      pmc          = {pmc:PMC5968045},
      doi          = {10.1007/s10654-018-0404-x},
      url          = {https://inrepo02.dkfz.de/record/134862},
}