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The first randomised trial of screening colonoscopy itself. Inviting people to one colonoscopy cut bowel cancer cases by 18 percent over ten years, less than expected, largely because only 42 percent of those invited turned up.
Bretthauer, Løberg, Wieszczy and colleagues ran a pragmatic randomised trial in presumptively healthy men and women aged 55 to 64, drawn from population registries in Poland, Norway, Sweden and the Netherlands between 2009 and 2014, assigning them 1:2 either to an invitation to a single screening colonoscopy or to no invitation. The primary end points were the risks of colorectal cancer and related death; the secondary end point was death from any cause.
Follow-up data were available for 84,585 participants in Poland, Norway and Sweden: 28,220 invited, of whom 11,843 (42.0 percent) underwent screening, and 56,365 in usual care. Fifteen participants had major bleeding after polyp removal, and there were no perforations or screening-related deaths within 30 days.
Colonoscopy screening works, but the effect a health system gets is the effect of the invitation, not of the procedure; uptake, not test performance, is the binding constraint, and this is the trial that made that argument unavoidable.
The first molecular stool test to reach approval, and the template for the blood tests that followed: more sensitive for cancer, much less specific, and still poor at the precancerous lesions that screening is supposed to remove.
The clinical proof of Vogelstein's sequence: interrupting the adenoma-carcinoma pathway with a snare prevents the cancer, which is why colonoscopy is the only screening test that both detects and prevents.
The paper that made the adenoma detection rate the central quality measure of every screening endoscopy service, and the reason endoscopist-level auditing is a condition of accreditation.
Shares Multitarget stool DNA testing for colorectal-cancer screening, Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood) and the tag colorectal-evidence.
Shares UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set, Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late and the tag colorectal-evidence.
Shares Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, The hardest cancers are found late and the tag colorectal-evidence.
Shares Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths (National Polyp Study), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, The hardest cancers are found late and the tag colorectal-evidence.
Shares Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, The hardest cancers are found late, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Colonoscopy, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Colorectal cancer and the tag colorectal-evidence.