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New Study Reveals Substantial Reduction in Colorectal Cancer Incidence Through Screening Endoscopy

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In an era marked by medical advancements, a recent comprehensive study published in Nature Reviews Gastroenterology & Hepatology has brought to light the impactful role of screening endoscopy in the significant reduction of colorectal cancer (CRC) incidence.

This breakthrough comes at a crucial time, given the increasing global burden of CRC, which is the third most common type of cancer and the second leading cause of cancer-related deaths worldwide.

Colorectal cancer poses a serious threat globally, with 1.9 million new cases and over 900,000 deaths annually. Most CRCs develop over many years, offering a substantial window for early detection and prevention. Screening methods, especially faecal occult blood testing (FOBT) and endoscopic examinations such as colonoscopy and flexible sigmoidoscopy, have been pivotal in early detection. However, the uptake of such screening methods varies significantly across countries.

Several studies have demonstrated that screening significantly reduces CRC incidence and mortality. A meta-analysis revealed reductions in distal CRC incidence and mortality of about 64% and 66%, respectively, for those undergoing flexible sigmoidoscopy screening. Moreover, countries with long-standing screening programmes, such as the US, Germany, and Austria, have seen notable decreases in CRC incidence.

Randomised trials, considered the gold standard in medical research, have reaffirmed the benefits of endoscopic screening. Notably, the NordICC study reported an 18% reduction in CRC incidence and a non-significant 10% reduction in mortality in an intention-to-screen analysis. However, these results are thought to be conservative due to factors such as low screening adherence and the inclusion of prevalent, non-preventable CRC cases.

The effectiveness of screening programmes is highly dependent on adherence rates. Low adherence dilutes the impact of screening, leading to an underestimation of its benefits. Furthermore, the inclusion of prevalent CRC cases in study results, which cannot be prevented by screening, has led to an underrepresentation of the true preventive potential of these procedures.

The evidence underscores the effectiveness of endoscopic screening in reducing the incidence of CRC. Flexible sigmoidoscopy is estimated to reduce the risk of distal CRC by approximately 70%, and similar reductions are suggested for colonoscopy in total CRC risk. Given these findings, increasing the availability and uptake of effective CRC screening should be a public health priority. Additionally, the adoption of FIT-based screening programmes and informed choices about screening methods and intervals could further enhance the impact of these interventions.

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