Colonoscopy controversy highlights screening uptake problem

The faecal immunochemical test (FIT) is sent to every Australian aged 50-74, every two years. It’s not known why more people don’t take the test, said Professor Mark Jenkins, who is leading a program to increase screening participation rates.

Professor Mark Jenkins, of the University of Melbourne Centre for Cancer Research and Melbourne School of Population and Global Health,  recently spoke to Oncology Republic about surprisingly low results in the first RCT to measure effectiveness of colonoscopy as a population screening tool.

The NordicICC randomised control study, Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death, published in the NEJM , involved almost 85,000 people in Norway, Poland and Sweden, some of whom received an invitation to have a colonoscopy. It has elicited strong reactions and raised questions about conclusions drawn when only 42% of those invited to screen actually did so.

“It’s a great study if you’re testing how effective a rollout of a nation-wide colonoscopy screening program is going to be, but it’s not a great measure of benefit for an individual or for a clinician trying to decide whether or not to recommend their own patient for a colonoscopy,” said Professor Mark Jenkins, director of the Centre for Epidemiology & Biostatistics at the University of Melbourne.

“I think the per protocol analysis, which is the most favourable light you can put on this study, still indicates that it is not cost effective compared to our current program.”

“I’d be very surprised if you got a 42% uptake in Australia for a national colonoscopy program, given that you only get around that for the FIT home test kit, which is less involved,” he said.

Read more in Oncology Republic.

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