Critical Shortcoming of NordICC trial is in Interpretation of “Screening”

This Blog post represents a partnership between the Women in Medicine Summit and Healio Women in Oncology. An excerpt appears blow, and please find the full length piece at Healio’s Women in Oncology Blog

“Should you still get a colonoscopy?” “A landmark study...found only meager benefits for the group of people invited to get the procedure.” “Doctors push back against European study that casts doubt.”

These are just some of the media reports surrounding the Nordic-European Initiative on Colorectal Cancer (NordICC) Study Group paper, “Effect of colonoscopy screening on risks of colorectal cancer and related death,” published in The New England Journal of Medicine in October.

Having witnessed the recent explosion of medical misinformation, especially during the COVID-19 pandemic, I initially wondered why this study would be circulated by one of the most respected medical journals in the world. After reading the study design in more detail, I realized that the critical shortcoming of the study is the terminology employed by the authors; specifically, the interpretation of the word “screening.”

Screening saves lives

As a gastroenterologist with a primary focus in colorectal cancer screening and prevention, I recognize that colorectal cancer is the second leading cause of cancer death among American men and women combined. Colorectal cancer affects more than 150,000 Americans every year, with 52,580 expected deaths in 2022 alone. It is estimated that 60% of these deaths could be prevented with screening.

The good news is that colorectal cancer screening rates in the U.S. have steadily increased since the 1980s, with a subsequent decrease in colorectal cancer incidence.

As of 2020, 71.6% of adults aged 50 to 75 years reported being up to date with colorectal cancer screening using various modalities. However, the lifetime risk for developing colorectal cancer for an average-risk American is still one in 24. In comparison, the lifetime risk of dying in a car crash is estimated to be one in 107.

About the author: Divya B. Bhatt, MD is an assistant professor of internal medicine in the division of digestive and liver diseases at the University of Texas Southwestern Medical Center and the VA North Texas Health Care System.