Do Colonoscopies Save Lives?

The New England Journal of Medicine recently published a study that suggests the benefits of colonoscopies for cancer screening may be overestimated. Media reports around this new study may be misleading. National nonprofits Fight Colorectal Cancer (Fight CRC) and Colon Cancer Coalition are united in ensuring that the colorectal cancer (CRC) community and those who are eligible for screening understand that getting screened for CRC does save lives. 

The Northern-European Initiative on Colorectal Cancer (NordICC) Study, funded by The Research Council of Norway, performed a randomized trial involving healthy men and women 55 to 64 years of age in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. Study participants were randomly assigned to either receive an invitation to undergo a single-screen colonoscopy or receive no screening. Following the release of the study, Bloomberg reported, “Colonoscopy screening exams that are recommended for older U.S. adults failed to reduce the risk of death from colon cancer in a 10-year study that questions the benefits of the common procedure.” The population from this trial is a sample of patients from Poland, Norway, Sweden, and the Netherlands, but is by no means an exhaustive sample. Not all populations who are being screened are being looked at in any one single trial. 

A colonoscopy has traditionally been considered the “gold standard” for colon screening because it can both identify polyps and remove them during the same procedure. Colonoscopies are a visual screening option that allows a physician to see inside the colon and rectum, and during this examination a gastroenterologist can remove precancerous polyps. Gastrointestinal risks of colonoscopy are well-understood. Patients need to consider what is best for them and their individual risk factors. Colonoscopy is one of several screening options patients can choose from including many low-cost, non-invasive options that can be done at home.

“Surprised and disappointed by the findings of modest reduction in CRC incidence and no reduction in CRC mortality.” Dr. Aasma Shaukat, NYU Grossman School of Medicine Director GI Outcomes Research and fellow for the American College of Gastroenterology (ACG) shares her initial reaction to the study. 

Dr. Shaukat says it is key that people understand that, “adherence to colonoscopy was low, only 42%. The quality of the endoscopist was also low, with nearly 30% having adenoma detection rate (ADR) below 25%, which is what we consider the benchmark for high quality colonoscopists. Note that in the U.S., the average ADR for screening colonoscopy is 39%.” 

It is important to read past the headline. “The message around this study should be: The best screening test is the one that's completed, and individuals that choose to undergo colonoscopy can reduce their risk of developing and dying from colorectal cancer,” says Dr. Shaukat. “Screening is highly effective at preventing colorectal cancer and death from colorectal cancer. While we await more studies, these will inform us how different modalities stack up against each other. It still underscores the importance of getting screened.” 

“There are more than 44 million people who are 45 years old or older in the United States that need to be screened for colorectal cancer,” said Anjee Davis, Fight CRC President. “Numerous studies have underscored that when patients are given a choice they are more compliant and willing to be screened. There isn’t a silver bullet screening test. But if a patient completes a screening test that they choose, screening for colorectal cancer will save lives: That’s the message that needs to be heard.” 

"The bottom line remains: We can confidently say that on-time screening for colorectal cancer, including colonoscopy, saves lives, and that educating patients about the benefits, risks, and screening options empowers them to make appropriate decisions for their health," says Chris Evans, Colon Cancer Coalition President. "Unfortunately, this misleading headline and claim creates unneeded uncertainty within the minds of patients. At minimum, the study affirmed a 50% reduction in death for those that followed through and got their colonoscopy. We strongly encourage patients to continue to schedule and complete their colorectal cancer screenings." 

According to the Centers for Disease Control and Prevention (CDC), 68% of colorectal cancer (CRC) deaths could be prevented with increased screening, and one of the most effective ways to get screened is a colonoscopy. Advocacy organizations have worked hard to ensure that colorectal cancer screening starting at age 45 is covered by insurers. 

CDC RECOMMENDATIONS FOR COLORECTAL CANCER SCREENING 

Regular screening, beginning at age 45, is the key to preventing colorectal cancer and finding it early. The U.S. Preventive Services Task Force (USPSTF) recommends that adults ages 45 to 75 be screened for colorectal cancer. The USPSTF recommends that adults ages 76 to 85 talk to their doctor about screening.

The USPSTF recommends several CRC screening strategies, including stool tests, flexible sigmoidoscopy, colonoscopy, and CT colonography (virtual colonoscopy). 

However, you may need to be tested earlier than 45, or more often than other people, if you have any of the following: 

• Inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
• A personal or family history of colorectal cancer or colorectal polyps
• A genetic syndrome such as familial adenomatous polyposis (FAP) 
• A hereditary non-polyposis colorectal cancer (Lynch syndrome). 

**Insurance coverage for Follow-up Colonoscopy 

Colorectal cancer doesn’t discriminate: It impacts people of all races, genders, and ages. Fight CRC and Colon Cancer Coalition provide free resources on CRC screening. Visit FightCRC.org/screening or ColonCancerCoalition.org/get-educated/ to learn more.