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The first randomised trial of colonoscopy screening: being invited cut the risk of bowel cancer by about a fifth, but fewer than half of those invited attended, so the effect on deaths was small.
84,585 people were randomised; only 42% of the invited group had a colonoscopy. In the intention-to-screen analysis at 10 years, colorectal cancer risk was 0.98% in the invited group versus 1.20% in the usual-care group (risk ratio 0.82), and colorectal cancer death 0.28% versus 0.31% (risk ratio 0.90, not significant). Adjusted per-protocol analysis estimated a 31% reduction in cancer incidence and a 50% reduction in death among those who actually attended. The trial (NEJM 2022) reframed colonoscopy as a strong test but a weak programme where participation is low, strengthening the case for FIT-based programmes.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
A second publication from the NordICC trial, later than the first and described in its title as an update or longer-term analysis. Read it with the primary publication linked from the trial page; the record was linked automatically and its figures have not been checked by hand.
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.
Shares Minnesota Colon Cancer Control Study, Faecal immunochemical test (FIT), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Colorectal cancer.
Shares 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), Early-onset colorectal cancer (under 50), Screening.
Shares Minnesota Colon Cancer Control Study, Faecal immunochemical test (FIT), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Colorectal cancer.
Shares NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, Early-onset colorectal cancer (under 50), 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, Colorectal cancer.
Shares NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, 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 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), 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 NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, 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 Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Early-onset colorectal cancer (under 50), 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.