Colon cancer study findings are misleading – AGA statement

Recently, the findings of a 10-year study published in the New England Journal of Medicine questioned the benefits of colonoscopy screening exams as the common procedure failed to reduce the risk of death from colon cancer. In response to the study, the American Gastroenterological Association (AGA) released the statement below to its members which indicates that the conclusions of the study aren’t necessarily applicable to colorectal cancer screening in the US and have been misrepresented in the media. Contrary to the study’s findings, the AGA statement indicates, “Among patients who actually got the colonoscopy, results are much more impressive in CRC prevention (31% decrease) and mortality (50% decrease).” – Nadya Swart

Nordic colorectal cancer (CRC) study: 3 things to know + talking points for patients

This week’s New England Journal of Medicine includes a study from Norway on efficacy of colonoscopy. The conclusions aren’t necessarily applicable to colorectal cancer screening in the U.S. 

Here are a few issues to keep in mind when reading the study and talking with your patients: 

  1. This study shows that colonoscopy screening IS effective – if it is completed.

Only 42% of patients randomised to colonoscopy completed the test. Among patients who actually got the colonoscopy, results are much more impressive in CRC prevention (31% decrease) and mortality (50% decrease). These data show that colonoscopy is effective if it is completed.

  1. Quality matters.

In this study, many endoscopists had ADRs below the 25% benchmark. We know that low ADRs are associated with a higher risk of post-colonoscopy CRC.

  1. The benefits of colonoscopy take time.  

Detection and removal of polyps prevent future cancers. If we assume that the “usual care” patients had a similar rate of pre-cancerous polyps that are not removed, it will take time before they develop CRC. Hence differences between the two groups may increase with longer follow-up, which is planned. 

Talking points for your patients: 

  • Don’t let media headlines guide your health care decisions. Colonoscopy is effective in the US population and can cut your risk of dying from CRC.
  • Most of the patients in the Norway study skipped their colonoscopy. The test can’t prevent cancers if it isn’t done. 
  • Colorectal cancer screening saves lives. If you’re age 45+, get screened. Colonoscopy can detect and remove polyps so they do not develop into cancer.

If you know your adenoma detection rate, compare it to the rates of the doctors in the study.

Thanks to AGA president John Carethers and David Lieberman, chair of the AGA CRC TF, for his comments on this study. Read more about AGA’s CRC TF and our call for a national screening program.

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