ASGE Annual GI Advanced Practice Provider Course (On-Demand) - Clinical Case-Based Learning (Day Two)

ASGE_GHAPP NordICC Fact Sheet

Pdf Summary

The Nordic-European Initiative on Colorectal Cancer Trial (NordICC Trial) provides important information regarding colorectal cancer screening and the effectiveness of colonoscopy. Screening colonoscopy has been proven to save lives by detecting and removing adenomas and early cancers. It requires less frequent screening compared to other colorectal cancer screening tests.<br /><br />However, the NordICC Trial revealed that only 42% of participants invited to undergo screening colonoscopy actually did so, highlighting the importance of performing the procedure for it to be effective. In the trial, colonoscopy was estimated to reduce the incidence of colorectal cancer by 31% and the risk of colorectal cancer-related death by 50%.<br /><br />The study also found that almost 30% of the endoscopists involved in the trial did not meet the recommended adenoma detection rate (ADR) of 25%. A higher ADR is associated with a lower risk of future colorectal cancer.<br /><br />Patients with a family history of colon cancer and/or advanced adenomas, certain hereditary syndromes, or a personal history of colon adenomas or colon cancer should discuss screening and surveillance strategies with their gastroenterologists. These patients should not undergo stool-based tests like the fecal immunochemical test (FIT) or stool DNA testing (Cologuard).<br /><br />When discussing screening options with patients, it is important to emphasize that colonoscopy is highly operator dependent and the higher the pre-cancerous polyp (adenoma) detection rate, the lower the risk of future colorectal cancer. Patients of average risk should undergo colonoscopy every 10 years if the result is negative for adenomas and colorectal cancer.<br /><br />For patients who cannot or do not want to undergo colonoscopy, other options include FIT or stool DNA testing. However, positive results from these tests should be followed up with a confirmation colonoscopy.<br /><br />It is crucial to share these findings with the referral network and emphasize the importance of a higher ADR in reducing the incidence of colorectal cancer and related deaths. Colonoscopy remains the best and proven method to detect and prevent colorectal cancer.

Keywords

NordICC Trial

colorectal cancer screening

colonoscopy

adenomas

early cancers

screening tests

incidence of colorectal cancer

colorectal cancer-related death

adenoma detection rate

family history of colon cancer