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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.
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.
The 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%.
The trial prompted a wide debate about the real-world effect of colonoscopy programmes versus stool-test programmes.
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.
The first molecular stool test to reach approval, and the template for the blood tests that followed: more sensitive for cancer, much less specific, and still poor at the precancerous lesions that screening is supposed to remove.
The clinical proof of Vogelstein's sequence: interrupting the adenoma-carcinoma pathway with a snare prevents the cancer, which is why colonoscopy is the only screening test that both detects and prevents.
The paper that made the adenoma detection rate the central quality measure of every screening endoscopy service, and the reason endoscopist-level auditing is a condition of accreditation.
A cheap home stool test, repeated yearly or every two years and followed by colonoscopy when positive, prevents bowel cancer deaths. This is what national bowel screening programmes do today, with FIT replacing the older guaiac test.
Shares Minnesota trial: a yearly stool blood test cuts bowel cancer deaths by a third, Multitarget stool DNA testing for colorectal-cancer screening, Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Faecal immunochemical test (FIT).
Shares Minnesota trial: a yearly stool blood test cuts bowel cancer deaths by a third, Faecal immunochemical test (FIT), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), 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.
Shares UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set, Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), 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.
Shares Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, 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.
Shares Quality indicators for colonoscopy and the risk of interval cancer, UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set, Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood).
Shares Multitarget stool DNA testing for colorectal-cancer screening, Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Faecal immunochemical test (FIT), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood).
Shares Faecal immunochemical test (FIT), Colonoscopy, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), 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.
Shares Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths (National Polyp Study), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, 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.