{"entity":{"id":"paper-nordicc-nejm-2022","kind":"paper","name":"NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected","aka":[],"tldr":"NordICC, the first randomised trial of colonoscopy screening, invited 84,585 people aged 55 to 64 to a single colonoscopy or to no screening. Bowel cancer incidence fell 18% over ten years among those invited, but only 42% attended, and the fall in bowel cancer deaths did not reach statistical significance, fuelling debate over colonoscopy versus stool-test programmes.","summary":"NordICC randomised 84,585 people aged 55-64 in Poland, Norway and Sweden to an invitation to a single screening colonoscopy or to usual care with no screening. The primary endpoints were colorectal cancer incidence and death at 10 years, analysed by intention to screen.\n\nThe 10-year risk of colorectal cancer was 0.98% in the invited group and 1.20% in usual care (risk ratio 0.82). Colorectal cancer death was 0.28% versus 0.31%, not significantly different. In the adjusted per-protocol analysis, assuming everyone invited had attended, incidence fell 31% and death 50%.\n\nThe trial prompted a wide debate about the real-world effect of colonoscopy programmes versus stool-test programmes.","asOf":"2026-09-08","links":[{"label":"DOI","url":"https://doi.org/10.1056/NEJMoa2208375"},{"label":"ClinicalTrials.gov NCT00883792","url":"https://clinicaltrials.gov/study/NCT00883792"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/36214590/"}],"tags":[],"related":["paper-minnesota-fobt-nejm-1993","idea-prev-fit-risk-adapted-thresholds","idea-prev-screening-default-appointments","paper-zauber-national-polyp-study-colonoscopic-polypectomy-nejm-2012","paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010"],"cancers":["colorectal"],"sections":["early-detection","prevention"],"technologies":["colorectal-screening","colonoscopy","endoscopy"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["fit-test"],"trials":["nordicc"],"people":["michael-bretthauer"],"bottlenecks":["b-early-detection","b-prevention-adoption","b-overdiagnosis"],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2022,"doi":"10.1056/NEJMoa2208375","pmid":"36214590","authors":"Bretthauer M, Løberg M, Wieszczy P, et al.","paperType":"rct","findings":["Colorectal cancer incidence at 10 years: 0.98% vs 1.20% (RR 0.82, 95% CI 0.70-0.93) by intention to screen","Colorectal cancer death: 0.28% vs 0.31% (RR 0.90, 95% CI 0.64-1.16)","Only 42% of those invited underwent colonoscopy","Adjusted per-protocol estimate: incidence RR 0.69, death RR 0.50 among those who attended","Number needed to invite to prevent one cancer over 10 years: 455"],"whatItMeans":"A colonoscopy probably does reduce bowel cancer risk for the person who has it, but a programme that offers colonoscopy achieves much less if most people decline. Programmes based on stool tests with high uptake may deliver as much population benefit at lower cost and risk.","caveats":["Low participation dilutes the intention-to-screen effect; the per-protocol estimate relies on modelling assumptions","Ten years is short for a mortality endpoint after polyp removal; a 15-year analysis is planned","Adenoma detection rates varied between endoscopists and some were below quality thresholds","Results apply to a one-off colonoscopy at 55-64, not to repeated colonoscopy programmes as practised in the US"],"changedPractice":false,"participants":84585},"route":"/key-papers/paper-nordicc-nejm-2022/","neighbours":{"paper":[{"id":"paper-zauber-national-polyp-study-colonoscopic-polypectomy-nejm-2012","kind":"paper","name":"Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths (National Polyp Study)","route":"/key-papers/paper-zauber-national-polyp-study-colonoscopic-polypectomy-nejm-2012/"},{"id":"paper-minnesota-fobt-nejm-1993","kind":"paper","name":"Minnesota trial: a yearly stool blood test cuts bowel cancer deaths by a third","route":"/key-papers/paper-minnesota-fobt-nejm-1993/"},{"id":"paper-imperiale-multitarget-stool-dna-screening-nejm-2014","kind":"paper","name":"Multitarget stool DNA testing for colorectal-cancer screening","route":"/key-papers/paper-imperiale-multitarget-stool-dna-screening-nejm-2014/"},{"id":"paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010","kind":"paper","name":"Quality indicators for colonoscopy and the risk of interval cancer","route":"/key-papers/paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010/"}],"idea":[{"id":"idea-prev-fit-risk-adapted-thresholds","kind":"idea","name":"Personalised stool-test cut-offs by age, sex and prior results","route":"/ideas/idea-prev-fit-risk-adapted-thresholds/"},{"id":"idea-prev-screening-default-appointments","kind":"idea","name":"Send screening invitations with a pre-booked time, not a request to call","route":"/ideas/idea-prev-screening-default-appointments/"},{"id":"idea-crc-screening-uptake-and-age-extension","kind":"idea","name":"Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model","route":"/ideas/idea-crc-screening-uptake-and-age-extension/"},{"id":"idea-crc-uk-colonoscopy-capacity-and-fit-threshold","kind":"idea","name":"UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set","route":"/ideas/idea-crc-uk-colonoscopy-capacity-and-fit-threshold/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"},{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"technology":[{"id":"colorectal-screening","kind":"technology","name":"Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)","route":"/technologies/colorectal-screening/"}],"term":[{"id":"colonoscopy","kind":"term","name":"Colonoscopy","route":"/terms/colonoscopy/"},{"id":"endoscopy","kind":"term","name":"Endoscopy (EGD, EUS, ERCP)","route":"/terms/endoscopy/"},{"id":"fit-test","kind":"term","name":"Faecal immunochemical test (FIT)","route":"/terms/fit-test/"}],"trial":[{"id":"nordicc","kind":"trial","name":"NordICC (Nordic-European Initiative on Colorectal Cancer)","route":"/trials/nordicc/"}],"person":[{"id":"michael-bretthauer","kind":"person","name":"Michael Bretthauer","route":"/people/michael-bretthauer/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"},{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}],"roadmap":[{"id":"colorectal-roadmap","kind":"roadmap","name":"Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation","route":"/roadmaps/colorectal-roadmap/"}]}}