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

Michael Bretthauer; Magnus Løberg; NordICC Study Group; Paulina Wieszczy; Mette Kalager; Louise Emilsson; Kjetil Garborg; Maciej Rupinski; Evelien Dekker; Manon Spaander; Marek Bugajski; Øyvind Holme; Ann G. Zauber; Nastazja D. Pilonis; Andrzej Mroz; Ernst J. Kuipers; Joy Shi; Miguel A. Hernán; Hans Olov Adami; Jaroslaw Regula; Geir Hoff; Michal F. Kaminski

doi:10.1056/nejmoa2208375

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

Michael Bretthauer
, Magnus Løberg
, NordICC Study Group
, Paulina Wieszczy
, Mette Kalager
, Louise Emilsson
, Kjetil Garborg
, Maciej Rupinski
, Evelien Dekker
, Manon Spaander
, Marek Bugajski
, Øyvind Holme
, Ann G. Zauber
, Nastazja D. Pilonis
, Andrzej Mroz
, Ernst J. Kuipers
, Joy Shi
, Miguel A. Hernán
, Hans Olov Adami
, Jaroslaw Regula

Geir Hoff, Michal F. Kaminski

Gastroenterology & Hepatology

University of Oslo

Research output: Contribution to journal › Article › Academic › peer-review

633 Citations (Scopus)

Abstract

BACKGROUND Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear. METHODS We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio either to receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause. RESULTS Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden - 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93). The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95% CI, 270 to 1429). The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04). CONCLUSIONS In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening.

Original language	English
Pages (from-to)	1547-1556
Number of pages	10
Journal	The New England journal of medicine
Volume	387
Issue number	17
DOIs	https://doi.org/10.1056/nejmoa2208375
Publication status	Published - 27 Oct 2022

Bibliographical note

Funding Information:
Supported by research grants from the Research Council of Norway (197309), Nordic Cancer Union, Norwegian Cancer Society, and Health Fund of South-East Norway (5135); bowel preparation free of charge for colonoscopies in Norway from Dr. Falk Pharma; grants from the National Center for Research and Development of Poland (N R13 0024 04), Polish–Norwegian Research Program (Pol-Nor/204233/30/2013), Medical Center for Postgraduate Education (501-1-09-12-12/22), the Polish Foundation of Gastroenterology, the Dutch Ministry of Health and Health Care Prevention, Program–Implementation (ZonMw 2008), the Netherlands Organization for Health Research and Development of the Dutch Ministry of Health (ZonMw 120720012), the Center for Translational Molecular Medicine (CTMM DeCoDe-project), and the Swedish Cancer Foundation (2010/345 and CAN 2013/553); a Distinguished Professor Award from the Karolinska Institutet, Regional forskningsfond i Uppsala–Örebro regionen (2368/10-221, to Dr. Adami); and a grant from Afa (130072).

Publisher Copyright:
Copyright © 2022 Massachusetts Medical Society.

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10.1056/nejmoa2208375

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Bretthauer, M., Løberg, M., NordICC Study Group, Wieszczy, P., Kalager, M., Emilsson, L., Garborg, K., Rupinski, M., Dekker, E., Spaander, M., Bugajski, M., Holme, Ø., Zauber, A. G., Pilonis, N. D., Mroz, A., Kuipers, E. J., Shi, J., Hernán, M. A., Adami, H. O., ... Kaminski, M. F. (2022). Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. The New England journal of medicine, 387(17), 1547-1556. https://doi.org/10.1056/nejmoa2208375

@article{5cdeb81a043248a7b37fe424b5eb349d,

title = "Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death",

abstract = "BACKGROUND Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear. METHODS We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio either to receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause. RESULTS Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden - 28,220 in the invited group, 11,843 of whom (42.0\%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98\% in the invited group and 1.20\% in the usual-care group, a risk reduction of 18\% (risk ratio, 0.82; 95\% confidence interval [CI], 0.70 to 0.93). The risk of death from colorectal cancer was 0.28\% in the invited group and 0.31\% in the usual-care group (risk ratio, 0.90; 95\% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95\% CI, 270 to 1429). The risk of death from any cause was 11.03\% in the invited group and 11.04\% in the usual-care group (risk ratio, 0.99; 95\% CI, 0.96 to 1.04). CONCLUSIONS In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening.",

author = "Michael Bretthauer and Magnus L{\o}berg and \{NordICC Study Group\} and Paulina Wieszczy and Mette Kalager and Louise Emilsson and Kjetil Garborg and Maciej Rupinski and Evelien Dekker and Manon Spaander and Marek Bugajski and {\O}yvind Holme and Zauber, \{Ann G.\} and Pilonis, \{Nastazja D.\} and Andrzej Mroz and Kuipers, \{Ernst J.\} and Joy Shi and Hern{\'a}n, \{Miguel A.\} and Adami, \{Hans Olov\} and Jaroslaw Regula and Geir Hoff and Kaminski, \{Michal F.\}",

note = "Funding Information: Supported by research grants from the Research Council of Norway (197309), Nordic Cancer Union, Norwegian Cancer Society, and Health Fund of South-East Norway (5135); bowel preparation free of charge for colonoscopies in Norway from Dr. Falk Pharma; grants from the National Center for Research and Development of Poland (N R13 0024 04), Polish–Norwegian Research Program (Pol-Nor/204233/30/2013), Medical Center for Postgraduate Education (501-1-09-12-12/22), the Polish Foundation of Gastroenterology, the Dutch Ministry of Health and Health Care Prevention, Program–Implementation (ZonMw 2008), the Netherlands Organization for Health Research and Development of the Dutch Ministry of Health (ZonMw 120720012), the Center for Translational Molecular Medicine (CTMM DeCoDe-project), and the Swedish Cancer Foundation (2010/345 and CAN 2013/553); a Distinguished Professor Award from the Karolinska Institutet, Regional forskningsfond i Uppsala–{\"O}rebro regionen (2368/10-221, to Dr. Adami); and a grant from Afa (130072). Publisher Copyright: Copyright {\textcopyright} 2022 Massachusetts Medical Society.",

year = "2022",

month = oct,

day = "27",

doi = "10.1056/nejmoa2208375",

language = "English",

volume = "387",

pages = "1547--1556",

journal = "The New England journal of medicine",

issn = "0028-4793",

publisher = "Massachussetts Medical Society",

number = "17",

}

Bretthauer, M, Løberg, M, NordICC Study Group, Wieszczy, P, Kalager, M, Emilsson, L, Garborg, K, Rupinski, M, Dekker, E, Spaander, M, Bugajski, M, Holme, Ø, Zauber, AG, Pilonis, ND, Mroz, A, Kuipers, EJ, Shi, J, Hernán, MA, Adami, HO, Regula, J, Hoff, G & Kaminski, MF 2022, 'Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death', The New England journal of medicine, vol. 387, no. 17, pp. 1547-1556. https://doi.org/10.1056/nejmoa2208375

TY - JOUR

T1 - Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

AU - Bretthauer, Michael

AU - Løberg, Magnus

AU - NordICC Study Group

AU - Wieszczy, Paulina

AU - Kalager, Mette

AU - Emilsson, Louise

AU - Garborg, Kjetil

AU - Rupinski, Maciej

AU - Dekker, Evelien

AU - Spaander, Manon

AU - Bugajski, Marek

AU - Holme, Øyvind

AU - Zauber, Ann G.

AU - Pilonis, Nastazja D.

AU - Mroz, Andrzej

AU - Kuipers, Ernst J.

AU - Shi, Joy

AU - Hernán, Miguel A.

AU - Adami, Hans Olov

AU - Regula, Jaroslaw

AU - Hoff, Geir

AU - Kaminski, Michal F.

N1 - Funding Information: Supported by research grants from the Research Council of Norway (197309), Nordic Cancer Union, Norwegian Cancer Society, and Health Fund of South-East Norway (5135); bowel preparation free of charge for colonoscopies in Norway from Dr. Falk Pharma; grants from the National Center for Research and Development of Poland (N R13 0024 04), Polish–Norwegian Research Program (Pol-Nor/204233/30/2013), Medical Center for Postgraduate Education (501-1-09-12-12/22), the Polish Foundation of Gastroenterology, the Dutch Ministry of Health and Health Care Prevention, Program–Implementation (ZonMw 2008), the Netherlands Organization for Health Research and Development of the Dutch Ministry of Health (ZonMw 120720012), the Center for Translational Molecular Medicine (CTMM DeCoDe-project), and the Swedish Cancer Foundation (2010/345 and CAN 2013/553); a Distinguished Professor Award from the Karolinska Institutet, Regional forskningsfond i Uppsala–Örebro regionen (2368/10-221, to Dr. Adami); and a grant from Afa (130072). Publisher Copyright: Copyright © 2022 Massachusetts Medical Society.

PY - 2022/10/27

Y1 - 2022/10/27

N2 - BACKGROUND Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear. METHODS We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio either to receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause. RESULTS Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden - 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93). The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95% CI, 270 to 1429). The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04). CONCLUSIONS In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening.

AB - BACKGROUND Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear. METHODS We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio either to receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause. RESULTS Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden - 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93). The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95% CI, 270 to 1429). The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04). CONCLUSIONS In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening.

UR - https://www.scopus.com/pages/publications/85140269230

U2 - 10.1056/nejmoa2208375

DO - 10.1056/nejmoa2208375

M3 - Article

C2 - 36214590

AN - SCOPUS:85140269230

SN - 0028-4793

VL - 387

SP - 1547

EP - 1556

JO - The New England journal of medicine

JF - The New England journal of medicine

IS - 17

ER -

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

Abstract

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