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Advocates Underscore Importance of Colonoscopies

By Jonathan Springston, Editor, Relias Media

After European investigators published the results of a study of colonoscopies, several U.S. advocacy groups quickly issued responses to this seemingly straightforward report.

Researchers studied presumptively healthy men and women age 55 to 64 years in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. They randomly assigned study participants to receive an invitation to undergo a single screening colonoscopy (the invited group; n = 28,220) or to receive no invitation or screening (the usual-care group; n = 56,365).

Among the invited group, 11,843 underwent a screening. During a median follow-up of 10 years, the authors reported 259 cases of colorectal cancer in the invited group vs. 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group vs. 1.20% in the usual-care group, a risk reduction of 18%. “The risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening,” the authors concluded.

In an editorial that was published along with the research paper, the authors provided some caveats about the colonoscopy investigation, perhaps to prevent readers from jumping to incorrect conclusions.

Shortly after the paper was published online, several groups issued responses, pointing out perceived flaws in the research and explaining the importance of colonoscopies. The Colorectal Cancer Alliance (CCA) called the follow-up media reports on this paper “disappointing.”

“No one study from across the globe, or reckless news headlines inspired by it, should deter Americans from getting checked for colorectal cancer,” said CCA CEO Michael Sapienza. “Headlines can spread like wildfire, but our unequivocal message can extinguish doubt — colonoscopies save lives.”

The American Cancer Society (ACS) noted how 60% of participants in the invited group did not follow through with undergoing a colonoscopy. Regardless of participation rates, ACS observed how in this study, this was a one-time screening, even though colon cancer can develop over many years.

“In this study, patients were screened from 2009 to 2014 (so many less than 10 years ago),” ACS explained. “The time from polyps to cancer to mortality is almost always greater than this, so a much longer follow-up is needed. In other diseases, such as prostate cancer, screening data look much better over time.”

“It’s hard to know the value of a screening test when the majority of people in the study didn’t get it done,” added William Dahut, MD, chief scientific officer for ACS. “However, study patients who did undergo a colonoscopy had a 31% decrease in the risk of colorectal cancer as compared to those who were not screened. This result points to the value of continued screening.”

The American College of Surgeons (ACS) “recognizes global discrepancies in cancer screening recommendations across countries.” However, the group said it “remains committed to supporting U.S. evidence-based recommendations and practices based on decades of research, including the use of colonoscopy to screen for colorectal cancer.”

For more on this and related subjects, be sure to read the latest issues of Internal Medicine Alert.