The Norwegian Colorectal Cancer Prevention (NORCCAP) Screening Study

Gondal, Ghous; Grotmol, Tom; Hofstad, Bjørn; Bretthauer, Michael; Eide, Tor J.; Hoff, Geir

doi:10.1080/00365520310003002

Cited by 137 publications

(26 citation statements)

References 23 publications

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“…Details of the study design, baseline findings, and short-term follow-up have been published previously. 8,10,11 All participants who attended the screening examination provided written, informed consent. The study was approved by the Ethics Committee of South-East Norway and the Norwegian Data Inspectorate.…”

Section: Methodsmentioning

confidence: 99%

Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality

Holme

Løberg

Kalager

et al. 2014

JAMA

374

315

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Importance Colorectal cancer is a major health burden. Screening is recommended in many countries. Objective Estimate the effectiveness of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality in a population-based trial. Design Randomized controlled trial in individuals aged 50–64 years. Screening was performed in 1999–2000 (55–64 year age-group) and 2001 (50–54 year age-group). End of follow-up: Dec 31st 2011. Setting Population of Oslo city and Telemark County, Norway. Participants 100,210 individuals were identified in the screening areas. 1,415 individuals were excluded due to prior colorectal cancer, emigration, or death. Three individuals could not be traced in the population registry. Intervention Individuals randomized to the screening group were invited to screening. Within the screening group, individuals were randomized 1:1 to once-only flexible sigmoidoscopy or combination of once-only flexible sigmoidoscopy and fecal occult blood-testing (FOBT). Individuals with positive screening test (cancer, adenoma, polyp ≥10 mm, or positive FOBT) were offered colonoscopy. The control group received no intervention. Main outcome measures Colorectal cancer incidence and mortality. Results 98,792 individuals were included in the intention to screen analyses; 78,220 in the control group and 20,572 in the screening group (10,283 randomized to flexible sigmoidoscopy and 10,289 to flexible sigmoidoscopy and FOBT). Compliance with screening was 63%. After median 10.9 years, 71 individuals had died from colorectal cancer in the screening group, and 330 in the control group (31.4 vs. 43.1 deaths, absolute rate difference 11.7 (95% CI 3.0–20.4) per 100,000 person-years); hazard ratio [HR] 0.73 (95% confidence interval [CI] 0.56–0.94). Colorectal cancer was diagnosed in 253 individuals in the screening group, and 1,086 in the control group (112.6 vs. 141.0 cases, absolute rate difference: 28.4 (95% CI 12.1–44.7) per 100,000 person-years); HR 0.80 (95% CI 0.70–0.92). Colorectal cancer incidence was reduced in both the 50–54 year age-group (HR 0.68; 95% CI 0.49–0.94) and the 55–64 year age-group (HR 0.83; 95% CI 0.71–0.96). There was no difference between the flexible sigmoidoscopy only and the flexible sigmoidoscopy/FOBT screening groups. Conclusion and relevance In Norway, once-only flexible sigmoidoscopy screening or flexible sigmoidoscopy and FOBT reduced colorectal cancer incidence and mortality on a population level compared with no screening. Screening was effective both in the 50–54 and the 55–64 year age-group. Trial registration ClinicalTrials identifier NTC00119912, http://clinicaltrials.gov

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Section: Methodsmentioning

confidence: 99%

Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality

Holme

Løberg

Kalager

et al. 2014

JAMA

374

315

View full text Add to dashboard Cite

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“…Sensitivity and specificity of gFOBT and FIT were derived from pooled analysis of information from diagnostic cohort studies (i.e. the diagnosis had not been determined prior to recruitment, and all participants underwent the index test and reference standard test), which included ‘screening populations' and, for gFOBT, which used Hemoccult (Beckman Coulter, Inc., Brea, CA, USA) or Hemoccult II (Allison et al , 1990, 1996, 2007; Castiglione et al , 1991; Foley et al , 1992; Itoh et al , 1996; Brevinge et al , 1997; Chen et al , 1997; Nakama et al , 2000, 2001; Lieberman and Weiss, 2001; Cheng et al , 2002; Niv et al , 2002; Gondal et al , 2003; Liu et al , 2003; Sung et al , 2003; Collins et al , 2005; Morikawa et al , 2005, 2007; Nakazato et al , 2006). Three studies were combined to estimate sensitivity of FSIG for intermediate/high-risk adenomas (Rozen et al , 1987, Lieberman and Weiss, 2001; Sung et al , 2003).…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of population-based screening for colorectal cancer: a comparison of guaiac-based faecal occult blood testing, faecal immunochemical testing and flexible sigmoidoscopy

et al. 2012

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Background:Several colorectal cancer-screening tests are available, but it is uncertain which provides the best balance of risks and benefits within a screening programme. We evaluated cost-effectiveness of a population-based screening programme in Ireland based on (i) biennial guaiac-based faecal occult blood testing (gFOBT) at ages 55–74, with reflex faecal immunochemical testing (FIT); (ii) biennial FIT at ages 55–74; and (iii) once-only flexible sigmoidoscopy (FSIG) at age 60.Methods:A state-transition model was used to estimate costs and outcomes for each screening scenario vs no screening. A third party payer perspective was adopted. Probabilistic sensitivity analyses were undertaken.Results:All scenarios would be considered highly cost-effective compared with no screening. The lowest incremental cost-effectiveness ratio (ICER vs no screening €589 per quality-adjusted life-year (QALY) gained) was found for FSIG, followed by FIT (€1696) and gFOBT (€4428); gFOBT was dominated. Compared with FSIG, FIT was associated with greater gains in QALYs and reductions in lifetime cancer incidence and mortality, but was more costly, required considerably more colonoscopies and resulted in more complications. Results were robust to variations in parameter estimates.Conclusion:Population-based screening based on FIT is expected to result in greater health gains than a policy of gFOBT (with reflex FIT) or once-only FSIG, but would require significantly more colonoscopy resources and result in more individuals experiencing adverse effects. Weighing these advantages and disadvantages presents a considerable challenge to policy makers.

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“…The KAM cohort (Kolorektal cancer, Arv og Miljø) is based primarily on the screening group of the Norwegian Colorectal Cancer Prevention study (the NORCCAP study) in the county of Telemark, Norway [21]. Additionally, a series of colorectal cancer cases was recruited to the KAM cohort from routine clinical work at Telemark Hospital in Skien and Ullevål University Hospital in Oslo.…”

Section: Methodsmentioning

confidence: 99%

Collagen mRNA levels changes during colorectal cancer carcinogenesis

et al. 2009

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BackgroundInvasive growth of epithelial cancers is a complex multi-step process which involves dissolution of the basement membrane. Type IV collagen is a major component in most basement membranes. Type VII collagen is related to anchoring fibrils and is found primarily in the basement membrane zone of stratified epithelia. Immunohistochemical studies have previously reported changes in steady-state levels of different α(IV) chains in several epithelial cancer types. In the present study we aimed to quantitatively determine the mRNA levels of type IV collagen (α1/α4/α6) and type VII collagen (α1) during colorectal cancer carcinogenesis.MethodsUsing quantitative RT-PCR, we have determined the mRNA levels for α1(IV), α4(IV), α6(IV), and α1(VII) in colorectal cancer tissue (n = 33), adenomas (n = 29) and in normal tissue from the same individuals. In addition, corresponding tissue was examined from healthy volunteers (n = 20). mRNA levels were normalized to β-actin. Immunohistochemical analysis of the distributions of type IV and type VII collagens were performed on normal and affected tissues from colorectal cancer patients.ResultsThe α1(IV) and α1(VII) mRNA levels were statistically significantly higher in colorectal cancer tissue (p < 0.001) as compared to corresponding tissue from healthy controls. This is an early event as tissue from adenomas also displayed a higher level. There were small changes in the levels of α4(IV). The level of α6(IV) was 5-fold lower in colorectal cancer tissue as compared to healthy individuals (p < 0.01). The localisation of type IV and type VII collagen was visualized by immunohistochemical staining.ConclusionOur results suggest that the down-regulation of α6(IV) mRNA coincides with the acquisition of invasive growth properties, whereas α1(IV) and α1(VII) mRNAs were up-regulated already in dysplastic tissue. There are no differences in collagen expression between tissues from healthy individuals and normal tissues from affected individuals.

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The Norwegian Colorectal Cancer Prevention (NORCCAP) Screening Study

Abstract: The present study bodes well for future management of a national screening programme, provided that follow-up results reflect adequate proof of a net benefit. It is highly questionable whether the addition of once-only FOBT to FS will contribute to this effect.

Cited by 137 publications

References 23 publications

Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality

Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality

Cost-effectiveness of population-based screening for colorectal cancer: a comparison of guaiac-based faecal occult blood testing, faecal immunochemical testing and flexible sigmoidoscopy

Collagen mRNA levels changes during colorectal cancer carcinogenesis

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