ArticleJournal of the National Cancer Institute2025
Contrasts in colorectal cancer incidence and mortality in screening trials of sigmoidoscopy vs the Nordic-European Initiative on Colorectal Cancer colonoscopy trial.
Article in Journal of the National Cancer Institute, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundInterim 10-year results from the Nordic-European Initiative on Colorectal Cancer (NordICC), a randomized controlled trial (RCT) of screening colonoscopy, demonstrated a statistically significant reduction in colorectal cancer (CRC) incidence but not mortality, contrary to results from 4 flexible sigmoidoscopy RCTs.
methodsWe constructed CRC incidence and mortality Kaplan-Meier curves through 10 years to standardize comparisons across RCTs and examined CRC screen detection and stage. Novel analyses of 1 flexible sigmoidoscopy RCT (Prostate, Lung, Colorectal, and Ovarian cancer screening trial [PLCO]) assessed year-by-year mortality in screen-detected CRCs.
resultsAt 10 years, all RCTs demonstrated statistically significant CRC incidence reductions with screening (ratio = 0.77, 95% confidence interval [CI] = 0.70 to 0.84, to ratio = 0.82, 95% CI = 0.69 to 0.97, vs control arm; P ≤ .011). Two flexible sigmoidoscopy RCTs and NordICC showed no statistically significant CRC mortality reduction (ratio = 0.84, 95% CI = 0.64 to 1.10, to ratio = 0.90, 95% CI = 0.69 to 1.18; P = .10-0.23). In 3 flexible sigmoidoscopy RCTs and NordICC, relative reductions were greater in CRC incidence than CRC mortality, but only NordICC reported higher CRC mortality with screening vs the control arm for the first 7 years. In contrast, PLCO observed fewer CRC deaths with screening by year 2 (ratio = 0.59; P = .03), and screen-detected CRCs were less often advanced (odds ratio = 0.26; P < .001) or fatal (ratio = 0.50; P < .001).
conclusionsAfter 10 years, NordICC is similar to 2 flexible sigmoidoscopy RCTs in observing statistically significant reductions in CRC incidence but not CRC mortality. However, only NordICC observed greater CRC mortality with screening vs the control arm for 7 years. Granular analyses of CRC cases and deaths in NordICC, paralleling our PLCO analyses, could provide insight into why CRC mortality results differ in NordICC vs flexible sigmoidoscopy RCTs.
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