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A new study raises unexpected questions about colonoscopy as primary screening method
Ist Teil von
Läkartidningen, 2023-01, Vol.120
Ort / Verlag
Sweden
Erscheinungsjahr
2023
Link zum Volltext
Quelle
MEDLINE
Beschreibungen/Notizen
Convincing data in the literature demonstrate that screening reduces mortality in colorectal cancer. A recent study (NordICC) randomising nearly 85 000 healthy men and women drawn from population registries in Norway, Poland and Sweden to either colonoscopy or no screening reported 18 % reduction in incidence of colorectal cancer but no effect on mortality at 10-year follow-up. This finding is in contrast to previous randomised studies on sigmoidoscopy and cohort studies on coloscopy showing clear-cut effects on both colorectal cancer incidence and mortality. There could be several explanations for these discrepancies. In the NordICC study, only 42 % of the invited individuals performed a colonoscopy compared to 60-90 % in the other studies. Moreover, the follow-up time was only 10 years, and longer follow-up times will clarify the results better especially considering the fact that the number of colorectal cancer cases increases in the colonoscopy arms during the first year due to detection of presymptomatic cancers. Finally, adenoma detection rate varied a lot and nearly 30 % of the colonoscopists in the NordICC study had an adenoma detection rate below the recommended level of 25 %. Nonetheless, this is an important study that raises critical questions about colonscopy as a primary screening method for colorectal cancer.