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Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death
Michael Bretthauer1, Magnus Løberg1, Paulina Wieszczy1
1From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.).
Inviting individuals aged 55-64 for a single screening colonoscopy reduced colorectal cancer risk by 18% over 10 years. This study clarifies the benefits of colonoscopy screening for colorectal cancer prevention.
Area of Science:
- Gastroenterology
- Preventive Medicine
- Oncology
Background:
- Colonoscopy is a common screening tool for colorectal cancer.
- The precise impact of colonoscopy on colorectal cancer incidence and mortality remains under investigation.
Purpose of the Study:
- To evaluate the effectiveness of a single screening colonoscopy in reducing the risk of colorectal cancer and related mortality.
- To assess the impact of screening invitations on overall mortality.
Main Methods:
- A pragmatic, randomized trial involving 84,585 participants aged 55-64 from population registries in Poland, Norway, and Sweden.
- Participants were randomized 1:2 to receive an invitation for a single screening colonoscopy or usual care (no invitation/screening).
- Primary endpoints included risks of colorectal cancer and related death; secondary endpoint was all-cause mortality, with a median follow-up of 10 years.
Main Results:
- In intention-to-screen analyses, the invited group showed an 18% reduction in colorectal cancer risk at 10 years (0.98% vs. 1.20%).
- The risk of death from colorectal cancer was similar between groups (0.28% vs. 0.31%).
- No significant difference in all-cause mortality was observed between the invited and usual-care groups.
Conclusions:
- Invitation for a single screening colonoscopy significantly lowers the risk of developing colorectal cancer.
- The study provides evidence supporting the role of screening colonoscopy in colorectal cancer prevention programs.
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