As the American Society of Colon and Rectal Surgeons, it is our mission to advance the understanding, prevention and treatment of colorectal cancer. Colorectal surgeons are uniquely involved in every aspect of colon cancer care including prevention, diagnosis, treatment, and surveillance.
The findings of the recent NordICC study, published in the New England Journal of Medicine, have generated significant media attention, calling into question the benefit of screening colonoscopy in preventing colorectal cancer. It is vitally important to us to clarify the findings of the study to avoid misinterpretation.
The NordICC study enrolled over 84,000 patients in Poland, Norway, and Sweden, and randomized them to either receive an invitation to undergo screening colonoscopy, or to follow usual care. Strikingly, only 42% of the invited patients actually underwent colonoscopy, and this significantly diluted the benefits of colonoscopy in the study. While the group invited to undergo colonoscopy had an 18% reduction in the risk of colorectal cancer after a decade of follow-up, there was no difference in the two groups with regard to risk of death from colorectal cancer (0.25% vs. 0.31%). Importantly, the investigators calculated that, had all invited patients undergone the screening colonoscopy, they would have had a 30% reduction in the risk of colorectal cancer and 50% reduction in the risk of death due to colorectal cancer.
Therefore, based on the findings of this study and many others, the ASCRS still recommends screening colonoscopy beginning at age 45 for average risk patients, in accordance with the American Cancer Society guidelines. Colonoscopy is the most effective test to prevent, diagnose and reduce the incidence of colorectal cancer. Patients may also consider alternatives to screening colonoscopy after discussing with their primary care physician. Options include flexible sigmoidoscopy, CT colonography (“virtual colonoscopy”), as well as stool-based tests such as the fecal immunochemical test (FIT), fecal occult blood test, and fecal DNA tests. The ASCRS is committed to improving access to colonoscopy and awareness of alternative screening options in order to have the greatest impact on prevention of colorectal cancer.