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Reduction in colorectal cancer incidence by screening endoscopy

Nature Reviews Gastroenterology & Hepatology volume 21, pages 125–133 (2024)Cite this article

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Abstract

Colorectal cancer (CRC) incidence rates decreased by up to 50% in older age groups in the USA in the era of the widespread uptake of screening colonoscopy, despite adverse trends in CRC risk factors and increasing CRC incidence at younger ages. However, reported first results from a randomized trial, the NordICC study, suggested rather modest effects of screening colonoscopy. As outlined in this Perspective, the apparent discrepancy between real-world and trial evidence could be explained by strong attenuation of effect estimates from screening endoscopy trials by several factors, including limited screening adherence, widespread uptake of colonoscopy outside the screening offers and the inclusion of prevalent, non-preventable CRC cases in reported numbers of incident cases. Alternative interpretations of screening endoscopy trial results accounting for prevalence bias are in line with trends in CRC incidence reduction in countries offering CRC screening, and should encourage more widespread implementation and uptake of effective CRC screening.

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Fig. 1: Changes in age-standardized CRC incidence between 2000 and 2016 in selected countries with differing levels of CRC screening implementation.
Fig. 2: Colonoscopy uptake in countries for which endoscopy trial results are available.
Fig. 3: Alternative interpretation of findings of the effects of screening on CRC incidence in the UK Flexible Sigmoidoscopy Screening trial46.

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Data availability

All data presented in this paper were extracted from published original articles or publicly accessible online data sources (including GLOBOCAN and the German Centre for Cancer Registry Data (ZfKD)) and can be retrieved from the references provided in the figure legends.

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Acknowledgements

This work was supported in part by grants from the German Federal Ministry of Education and Research (grant no. 01KD2104A) and the German Cancer Aid (grant no. 70114735).

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Authors and Affiliations

  1. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Hermann Brenner, Thomas Heisser, Rafael Cardoso & Michael Hoffmeister

  2. Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumour Diseases (NCT), Heidelberg, Germany

    Hermann Brenner

  3. German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany

    Hermann Brenner

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All authors made substantial contributions to discussion of content and reviewed/edited the manuscript before submission. H.B. researched data for and wrote the article.

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Correspondence to Hermann Brenner.

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Brenner, H., Heisser, T., Cardoso, R. et al. Reduction in colorectal cancer incidence by screening endoscopy. Nat Rev Gastroenterol Hepatol 21, 125–133 (2024). https://doi.org/10.1038/s41575-023-00847-3

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