NordICC (Nordic-European Initiative on Colorectal Cancer)
The first randomised trial of colonoscopy screening: being invited cut the risk of bowel cancer by about a fifth, but fewer than half of those invited attended, so the effect on deaths was small.
Overview
84,585 people were randomised; only 42% of the invited group had a colonoscopy. In the intention-to-screen analysis at 10 years, colorectal cancer risk was 0.98% in the invited group versus 1.20% in the usual-care group (risk ratio 0.82), and colorectal cancer death 0.28% versus 0.31% (risk ratio 0.90, not significant). Adjusted per-protocol analysis estimated a 31% reduction in cancer incidence and a 50% reduction in death among those who actually attended. The trial (NEJM 2022) reframed colonoscopy as a strong test but a weak programme where participation is low, strengthening the case for FIT-based programmes.
- 1 vs 1.2 out of 100 reached this endpoint at 10 years with Invited to colonoscopy compared with Usual care; 0.2 fewer per 100.
- On this measure the first group did worse, not better.
- Put another way, the treated group had about 18 percent lower chance of the event at any given time (hazard ratio 0.82, likely range 0.7 to 0.93).
- 0.3 vs 0.3 out of 100 reached this endpoint at 10 years with Invited to colonoscopy compared with Usual care; 0 fewer per 100.
- On this measure the first group did worse, not better.
- Put another way, the treated group had about 10 percent lower chance of the event at any given time (hazard ratio 0.9, likely range 0.64 to 1.16).
- The likely range for the hazard ratio crosses 1, so the difference could be due to chance.
- This endpoint is not one of the standard survival or response measures; read it alongside the trial's primary result.
- These results apply to the people the trial enrolled: Population-based randomised trial of invitation to a single screening colonoscopy versus no invitation in Poland, Norway and Sweden, adults aged 55 to 64. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
84,585 participants enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Colorectal cancer incidence at 10 years (intention to screen)primary | Invited to colonoscopy | — | 0.98% | 0.82 (0.7–0.93) | — | link |
| Usual care | — | 1.2% | ||||
| Colorectal cancer death at 10 years | Invited to colonoscopy | — | 0.28% | 0.9 (0.64–1.16) | — | — |
| Usual care | — | 0.31% |
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