Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

Bretthauer, Michael; Løberg, Magnus; Wieszczy, Paulina; Kalager, Mette; Emilsson, Louise; Garborg, Kjetil; Rupiński, Maciej; Dekker, Evelien; Spaander, Manon; Bugajski, Marek; Holme, Øyvind; Zauber, Ann G.; Pilonis, Nastazja D.; Mróz, Andrzej; Kuipers, Ernst J.; Shi, Julie; Hernán, Miguel A.; Adami, Hans‐Olov; Reguła, Jarosław; Hoff, Geir; Kamiński, Michał

doi:10.1056/nejmoa2208375

Cited by 401 publications

(285 citation statements)

References 25 publications

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“…Long-term outcomes from several RCTs on the effects of screening colonoscopy are still pending [24][25][26][27]. Initial results from the north-European NordICC trial were recently published [8]. However, given that follow-up so far was limited to 10 years, results are to be considered preliminary [28].…”

Section: Findings In Contextmentioning

confidence: 99%

“…By contrast, measured incidence shows an initial apparent increase in the screening group due to detection of prevalent, preclinical cancer. Only in the long run, typically after around 4 to 6 years of follow-up, measured cumulative incidence also starts to be lower in the screening group due to later manifestation of initially preclinical cases in the control group and removal of precancerous lesions in the screening group [3–8].…”

Section: Introductionmentioning

confidence: 99%

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Disclosing the true impact of screening endoscopy on colorectal cancer incidence

Heisser

Senore

Hoffmeister

et al. 2022

Preprint

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Objectives Randomized trials have demonstrated reduction of colorectal cancer (CRC) incidence by screening endoscopy. However, measured reduction underestimates true reduction due to inclusion of preclinical cases already present at recruitment. We aimed to quantify the true impact of screening endoscopy on reducing the CRC incidence. Design Simulation study replicating reported CRC incidence by SCORE, a large, randomized screening sigmoidoscopy trial, and deriving expected incidence after excluding cases that manifested during follow-up but were already prevalent at baseline. Setting Offer of a single flexible sigmoidoscopy in an organised, population-based screening setting. Participants Simulated, sex- and age-matched SCORE trial population (intervention group, N=17,136, control group, N=17,136, 50% women, ages 55-64 at baseline). Interventions Screening flexible sigmoidoscopy versus no screening. Main outcome measure 'True' (i.e., unbiased, excluding prevalent cancers at baseline) and 'apparent' (i.e., as reported) incidence rate ratios (IRR) for screening versus no screening. Results In the initial years after randomization, apparent cumulative incidence in the screening group was higher than in the control group due to inclusion of a large proportion of prevalent cancers. In the longer run, apparent cumulative incidence was lower in the screening group, but this incidence reduction was still much lower than true incidence reduction due to inclusion of prevalent cases in calculation of apparent cumulative incidence. In intention-to-screen analysis, apparent/true risk reductions after 8, 11 and 15 years of follow-up were 16%/31%, 20%/28%, and 21/25%, respectively. In per-protocol analyses, respective apparent/true risk reductions were 28%/54%, 34%/49%, and 35%/44%. Estimated underestimation of true incidence was similar among men and women and among age groups 55-59 and 60-64. Conclusions The preventive effect of screening endoscopy is likely much stronger than reflected in the reported apparent IRRs. Published findings of randomized screening trials underestimate the true preventive effective of screening endoscopy even after 15 year or longer follow-up.

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Section: Findings In Contextmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Disclosing the true impact of screening endoscopy on colorectal cancer incidence

Heisser

Senore

Hoffmeister

et al. 2022

Preprint

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“…Como se refleja en el resumen, los autores encontraron una disminución de la incidencia de CCR, pero sin una reducción significativa en la mortalidad 1 . Algunas de las potenciales explicaciones para estos resultados incluyen la baja adherencia de los participantes al tamizaje (sólo el 42 % de las personas invitadas realizó la VCC); el tiempo de seguimiento, que podría ser insuficiente para observar beneficios en la mortalidad (los autores planean repetir el análisis a los 15 años de seguimiento); la habilidad de los endoscopistas que participaron en el estudio (el 29 % de los cuales tenía una tasa de detección de adenomas menor a la recomendada); y una alta tasa de detección de CCR en algunas regiones, lo cual podría reflejar una tendencia de pacientes de alto riesgo o sintomáticos a aceptar la invitación del tamizaje y llevar a una subestimación de los efectos de esta intervención en pacientes asintomáticos de riesgo promedio 8 .…”

Section: Comentariounclassified

Resultados del primer ensayo clínico aleatorizado de tamizaje de cáncer de colon con colonoscopía

Sguiglia

2022

Evid actual pract ambul

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“…Fortunately, the incidence of CRC has been decreasing over the last thirty years, attributable in part to screening and surveillance modalities, including colonoscopies [ 2 ]. The recent randomized control NordICC trial demonstrated that screening colonoscopies decreased the risk of CRC at 10 years by 18% [ 3 ]. Guidelines for CRC screening in average risk patients vary by country, but in general, endoscopic screening is part of the algorithm.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Interval Colorectal Cancer: A Canadian Retrospective Population-Level Analysis from Newfoundland and Labrador

et al. 2022

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Interval colorectal cancers (I-CRCs) arise during the interval time period between scheduled colonoscopies. Predicting which patients are at risk of I-CRCs remains an elusive undertaking, but evidence would suggest that most I-CRCs arise from lesions missed on index endoscopy. The procedural factors that lead to missed lesions are numerous and lack consensus in the literature. In Canada, the province of Newfoundland and Labrador has the highest incidence of CRCs. In this study our aim was to examine I-CRCs (3–60 months after last colonoscopy) in NL through a population-level analysis covering 67% of the province from 2001–2018. We estimated the I-CRC rate to be up to 9.3%. Median age of I-CRC diagnosis was 67.1 years with an interval time of 2.9 years. About 57% of these tumors occurred proximal to the splenic flexure, with 53% presenting as local disease. No temporal differences were observed in interval time or tumor distribution. On univariate and multivariable logistical regression, risk of right-sided I-CRC did not correlate to the index colonoscopy indication, bowel preparation quality, size of largest polyp removed, colonoscopy completion rate, or stage at presentation. Improvements in synoptic reporting utilization and national registries are needed to identity risk factors and reduce I-CRC frequency.

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Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

Cited by 401 publications

References 25 publications

Disclosing the true impact of screening endoscopy on colorectal cancer incidence

Disclosing the true impact of screening endoscopy on colorectal cancer incidence

Resultados del primer ensayo clínico aleatorizado de tamizaje de cáncer de colon con colonoscopía

Characteristics of Interval Colorectal Cancer: A Canadian Retrospective Population-Level Analysis from Newfoundland and Labrador

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