ASGE Annual GI Advanced Practice Provider Course (On-Demand) - Onboarding (Day One)

ASGE_GHAPP NordICC Fact Sheet

Pdf Summary

The Nordic-European Initiative on Colorectal Cancer Trial (NordICC) is a study that emphasizes the importance of screening colonoscopy in saving lives by both detecting and removing adenomas and early cancers. This procedure requires less frequent screening compared to other colorectal cancer screening tests. However, only 42% of participants in the trial actually underwent colonoscopy, highlighting the need for effective implementation.<br /><br />The NordICC trial found that in the adjusted per-protocol analysis, colonoscopy reduced the incidence of colorectal cancer by 31% and the risk of related death by 50%. This aligns with previous cohort studies. It is important to note that not all endoscopists in the trial met the recommended adenoma detection rate (ADR) of 25%. Higher ADRs are associated with lower future incidence of colorectal cancer and lower CRC-related death rates.<br /><br />Patients with family history of colon cancer, advanced adenomas, certain hereditary syndromes, personal history of colon adenomas, or colon cancer should discuss screening and surveillance strategies with gastroenterologists. FIT and stool DNA testing (Cologuard) are not recommended for these patients.<br /><br />Patients should be aware that not all endoscopists meet the minimum required adenoma detection rate, and that colonoscopy is operator dependent. The higher the detection rate, the lower the risk of future colorectal cancer. Colonoscopy is the only screening test that detects and prevents colon cancer by removing pre-cancerous polyps.<br /><br />For average-risk patients, negative results from a colonoscopy require repeat exams every 10 years until age 75. FIT is recommended for yearly testing until age 75, while stool DNA testing (Cologuard) is advised every 3 years until age 75 if the results are negative. Positive FIT or stool DNA tests require a referral for colonoscopy to confirm or exclude the presence of cancer or high-risk polyps.<br /><br />Healthcare providers should understand that colonoscopy is highly operator dependent, and increasing the adenoma detection rate is associated with lower incidence of colorectal cancer and CRC-related deaths. Referral for colonoscopy is necessary for patients with positive FIT or stool DNA test results.

Keywords

NordICC trial

screening colonoscopy

adenomas

early cancers

colorectal cancer screening

incidence of colorectal cancer

related death

adenoma detection rate

gastroenterologists

pre-cancerous polyps