Doing more cancer screening won’t reduce Black-white health disparities

Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death

Authors: Michael Bretthauer, Magnus Løberg, Paulina Wieszczy, Mette Kalager, Louise Emilsson, Kjetil Garborg, Maciej Rupinski, Evelien Dekker, Manon Spaander, Marek Bugajski, Øyvind Holme, Ann G Zauber, Nastazja D Pilonis, Andrzej Mroz, Ernst J Kuipers, Joy Shi, Miguel A Hernán, Hans-Olov Adami, Jaroslaw Regula, Geir Hoff, Michal F Kaminski, and NordICC Study Group

Overview of the study

The study “Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death” by Michael Bretthauer et al. investigates the effectiveness of colonoscopy as a screening tool for colorectal cancer. The study, conducted in Poland, Norway, Sweden, and the Netherlands, involved a randomized trial where men and women aged 55 to 64 were either invited to undergo colonoscopy screening or received no screening (usual care). The primary endpoints were the risks of colorectal cancer and related death, while the secondary endpoint was death from any cause.

Key Findings:

• A 10-year follow-up showed a lower risk of colorectal cancer in the group invited for screening (0.98%) compared to the usual-care group (1.20%), with an 18% risk reduction.
• The risk of death from colorectal cancer was slightly lower in the invited group (0.28% vs. 0.31%), though this difference was not statistically significant.
• The number needed to invite for screening to prevent one case of colorectal cancer was 455.
• There was no significant difference in the overall mortality between the two groups.

Conclusion:

Colonoscopy screening reduced the risk of colorectal cancer over a 10-year period but had a minimal impact on reducing deaths from colorectal cancer or all-cause mortality. The findings suggest that while colonoscopy can be effective in detecting colorectal cancer, its impact on mortality may be less significant than previously thought.

Wafik S. El-Deiry shared his perspective on the study, on X:

“Good perspective.

But: It is important to be certain the screening is actually getting done, not just that patients enroll on a trial.

For example you can’t benefit if the colonoscopy isn’t done in an intent-to-screen analysis that includes patients who never get the screening.

Doing more cancer screening won’t reduce Black-white health disparities.”

Source: Wafik S. El-Deiry/X

Wafik El-Deiry, MD, PhD, FACP, FRSM, is the Associate Dean for Oncologic Sciences at the Warren Alpert Medical School and Director of the Legorreta Cancer Center at Brown University and Director of the Joint Program in Cancer Biology at Brown University and affiliated hospitals. He is the Editor in Chief at Oncotarget.

Dr. El-Deiry discovered p21(WAF1) as a p53 target gene, cell cycle inhibitor, and tumor suppressor that explained the mammalian cell stress response. Dr. El-Deiry’s research is focused on mechanisms of therapy resistance with major efforts in drug discovery and development.