(CTN News) – A large, 10-year randomized trial suggests that simply recommending a colorectal cancer screening procedure may not be as beneficial as hoped.
There was no difference in cancer death rates between healthy middle-aged people who received a colonoscopy or not, though those offered one had a lower risk of diagnosis.
These findings don’t necessarily prove colonoscopies aren’t worthwhile, but they will add fuel to the ongoing debate.
Nordic, or Nordic-European Initiative on Colorectal Cancer, is a pragmatic, randomized trial that aims to replicate real-world conditions. Poland, Norway, Sweden, and the Netherlands participated with no apparent increased risk of colorectal cancer.
These and other European countries do not recommend colonoscopy as often as the U.S. Participants were randomly divided into two groups: One group received one screening colonoscopy, and the other did not.
Researchers tracked the median 10-year cancer-related outcomes of nearly 85,000 people, including 28,220 in the invited group and 56,365 in the control group. 0.98% of the invited group were diagnosed with colorectal cancer, compared to 1.20% of the usual-care group.
However, around 0.3% of people in either group died of colorectal cancer over the 10-year period. Approximately 11% of both groups died from any cause. New England Journal of Medicine published the findings over the weekend.
A colonoscopy uses a long, camera-equipped tube to detect and remove suspicious growths inside the colon that could become cancerous.
The results of other observational studies suggest that colonoscopies can reduce the risk of death and diagnosis from colorectal cancer.
However, this is the first randomized trial to examine its potential in a real-world setting. The results aren’t so clear-cut about the procedure’s lack of value, though.
One caveat of the study is that only 42% of people invited to get a colonoscopy actually did. Researchers found that these people had significantly lower odds of developing and dying from colorectal cancer-about a 31% lower risk of diagnosis and a 50% lower risk of death.
Telling people to get a colonoscopy could very well benefit the whole population, but only if enough people follow the advice.
Outside researchers Jason Dominitz and Douglas Robertson highlighted these points and other important considerations in an accompanying editorial.
Anyhow, the researchers will keep studying their trial participants and plan to publish their findings after 15 years, while other relevant studies are going on right now. Either way, colonoscopies aren’t done for good.
Additional analyses, such as longer follow-up and results from other ongoing comparative effectiveness trials, will help us fully understand this test’s benefits, wrote the editorial’s authors.