Screening for colorectal cancer by nurse endoscopists

N Engl J Med. 1994 Jan 20;330(3):183-7. doi: 10.1056/NEJM199401203300307.


Background: Case-control studies have demonstrated that screening by sigmoidoscopy is effective in reducing mortality from colorectal cancer. If nurses performed screening examinations, more patients could be screened and, at current income levels, at a lower cost.

Methods: Two registered nurses and two licensed practical nurses learned to perform examinations with the flexible fiberoptic sigmoidoscope in order to screen patients for colorectal tumors. They performed 1881 independent examinations of outpatients more than 45 years of age. During the same period, 730 examinations were performed by two gastroenterologists in similar patients.

Results: The mean depth of insertion of the sigmoidoscope was slightly but significantly greater in the patients examined by the physicians than in those examined by the nurses (48 vs. 46 cm in men, P = 0.003; 41 vs. 38 cm in women, P = 0.002). Adenomas were found in 14 percent of the men and 8 percent of the women examined (P = 0.001). Nine cancers were found in men and four in women. There were no significant differences between the nurses and the physicians in the proportion of examinations that were positive for adenomas or cancer. No complications occurred during the initial examinations or during 894 follow-up sigmoidoscopic procedures. Among the patients whose initial examination results were normal, more of those examined by nurses returned for follow-up sigmoidoscopy after 12 months or more (45 percent, vs. 30 percent of those examined by physicians; P = 0.001).

Conclusions: Nurses can carry out screening by flexible sigmoidoscopy as accurately and safely as experienced gastroenterologists.

MeSH terms

  • Adenoma / diagnosis*
  • Aged
  • Analysis of Variance
  • Colorectal Neoplasms / diagnosis*
  • Female
  • Fiber Optic Technology
  • Humans
  • Louisiana
  • Male
  • Middle Aged
  • Nurses / psychology
  • Nurses / standards*
  • Nursing, Practical / standards
  • Process Assessment, Health Care*
  • Sensitivity and Specificity
  • Sex Factors
  • Sigmoidoscopy / methods
  • Sigmoidoscopy / nursing*
  • Sigmoidoscopy / standards