NordICC trial doesn’t change the value of colonoscopy
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Despite some sensational headlines following the publication of NordICC trial data in The New England Journal of Medicine, it’s important to understand that this study does not change the value of colonoscopy.
As GI physicians, we know that colonoscopy saves lives – it is the only test that screens, detects and prevents colorectal cancer. The most important takeaway from the study is that CRC screening is effective when it is performed. The NordICC trial data show that when people did get colonoscopy, it reduced the risk for CRC by 31% and cut the risk for dying from CRC by 50%.
The study results also reinforce that not getting a colonoscopy is of no value. Only 42% of the people invited to get a colonoscopy got the procedure. This should be a reminder to all of us that we need to work harder on education, raising awareness, expanding coverage and removing barriers to CRC screening.
We also know that this study doesn’t represent the state of CRC screening in the United States. Research on populations in Norway, Poland and Sweden may not be representative of the diverse populations we have in the U.S. and does not consider the impact of colonoscopy on communities of color, which have dramatically higher CRC incidence and death rates.
The importance of having highly skilled gastroenterologists performing colonoscopy is significant and more common in the U.S. A recent study using data from the GI Quality Improvement Consortium (GIQuIC) showed the average adenoma detection rate for screening colonoscopies was 39% in the United States (Shaukat A, et al.). In the NordICC trial, almost one-third of the endoscopists had an adenoma detection rate below the recommended minimum threshold of 25%.
Additionally, one in four of the colonoscopies performed were done with no sedation. This can increase discomfort, shorten the withdrawal time and potentially lead to decreased polyp detection. If physicians with high adenoma detection rates had done the procedures on that set of patients with sedation, it may have shown an increase in the preventive impact of colonoscopy.
Overall, the NEJM study emphasizes the critical importance of CRC screening. In the U.S., CRC is the second most common cause of cancer deaths for men and women combined, expected to cause more than 52,000 deaths this year. With early detection, the five-year survival for a localized CRC is more than 90%.
As a member of the Digestive Health Physicians Association, I’m proud to work with more than 2,500 physicians and other providers within our member practices who are on the front lines of diagnosing and treating patients with CRC. We all remain committed to advocating for policy changes and engaging in education and awareness initiatives that improve CRC screening rates.
Reference:
Shaukat A, et al. Am J Gastroenterol. 2021;doi:10.14309/ajg.0000000000001358.
For more information:
Nadeem Baig, MD, is vice president and chief medical officer of Allied Digestive Health in New Jersey and serves as the chair of communications for the Digestive Health Physicians Association.
Perspective
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Arielle Kanters, MD
The NordICC study suggests that colonoscopies have a lower rate of cancer detection and long-term colon cancer survival than previously thought. One fact remains — colonoscopies save lives. Colon cancer is the third most common cancer and second most common cause of cancer-related death. The results from this study need to be interpreted with caution, as they were analyzed only over a 10-year period.
Since one of the main benefits of a colonoscopy is treating precancerous polyps, it may take additional decades before we see the long-term benefit of colonoscopy screening. When we perform screening colonoscopies, our goal is not only to identify cancer but also to treat abnormal growths, or polyps, that could one day turn into a cancer.
There are multiple non-colonoscopy options for CRC screening — for example, looking for blood or atypical DNA in the stool — but ultimately a colonoscopy is still required to investigate a positive result or diagnose colon cancer.
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