Overview of the Study Findings
Updated findings from a European randomized trial continued to show that colonoscopy screening significantly reduced colorectal cancer (CRC) incidence, but its impact on CRC mortality was less clear.
At 13 years of follow-up, the incidence of CRC was 1.46% among participants who underwent colonoscopy screening versus 1.80% in the no-screening group, with a risk ratio (RR) of 0.81 (95% CI 0.71-0.90) in intention-to-screen analyses and 0.55 (95% CI 0.33-0.81) in per-protocol analyses.
However, there was no statistically significant difference in CRC mortality in the screening and no-screening groups (0.41% vs 0.47%, respectively), with risk ratios of 0.88 (95% CI 0.68-1.08) and 0.70 (95% CI 0.26-1.25) in the two types of analyses.
Study Presentation and Commentary
Results from the study were presented at the annual Digestive Disease Week meeting and published simultaneously in The Lancet.
The results were similar to those observed at the 10-year follow-up, which showed the risk of CRC was 0.98% in the screening group and 1.20% in the no-screening group (RR 0.82, 95% CI 0.70-0.93).
In an interview, Dr. Michael Bretthauer noted that a major criticism of the study at the 10-year mark was that it was too short of a follow-up to accurately gauge the impact of colonoscopy on CRC mortality.
Limitations and Changing Landscape
Moreover, he noted that CRC mortality in the no-screening group was substantially lower than expected at the time of designing the trial.
While the CRC mortality rate is not zero in the no-screening group, it’s approaching zero, making it difficult to obtain a better outcome.
Dr. Aasma Shaukat emphasized that the trial’s longer-term results compel a recalibration of what colonoscopy can achieve at the population level.
This evolving therapeutic landscape fundamentally changes the arithmetic of screening benefit, as colonoscopy clearly prevents some cancers, but the prognosis for clinically detected colorectal cancer is improving.
Implications for Clinical Practice
As indicated by the findings, while colonoscopy prevents some cancers, its overall benefits may be more modest than previously assumed.
The NordICC trial included 84,583 individuals from Norway, Poland, and Sweden, with a notable screening attendance of only 42%.
Dr. Bretthauer highlighted that colonoscopy is more effective in men compared to women, and better in the lower parts of the colon.
Specifically, the risk for distal CRC was significantly reduced in the screening group while the risk for proximal CRC showed a more modest decrease.
Conclusion
Finally, it is clear that while colonoscopy is an effective cancer-prevention intervention, policymakers should understand the modest or uncertain mortality benefits and consider value, as investments in other health interventions could yield larger gains in population health.
Disclaimer: This information is intended for educational purposes only and should not replace professional medical advice. Always consult a healthcare provider for personal medical advice.
Fuente: https://www.medpagetoday.com/meetingcoverage/ddw/121108
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