Population-Based Colonoscopy Screening for Colorectal Cancer

作者：Michael Bretthauer, Michał F. Kamiński, Magnus Løberg, Ann G. Zauber, Jarosław Reguła, Ernst J. Kuipers, Miguel A. Hernán, Eleanor McFadden, Annike Sunde, Mette Kalager, Evelien Dekker, Iris Lansdorp‐Vogelaar, Kjetil Garborg, Maciej Rupiński, Manon C.W. Spaander, Marek Bugajski, Ole Høie, Tryggvi Stefánsson, Geir Hoff, Hans‐Olov Adami, for the Nordic-European Initiative on Colorectal Cancer (NordICC) Study Group · 发表于：JAMA Internal Medicine · 年份：2016 · 被引用次数：326 · 研究领域：Colorectal Cancer Screening and Detection、Global Cancer Incidence and Screening、Gastric Cancer Management and Outcomes

IMPORTANCE: Although some countries have implemented widespread colonoscopy screening, most European countries have not introduced it because of uncertainty regarding participation rates, procedure-related pain and discomfort, endoscopist performance, and effectiveness. To our knowledge, no randomized trials on colonoscopy screening currently exist. OBJECTIVE: To investigate participation rate, adenoma yield, performance, and adverse events of population-based colonoscopy screening in several European countries. DESIGN, SETTING, AND POPULATION: A population-based randomized clinical trial was conducted among 94 959 men and women aged 55 to 64 years of average risk for colon cancer in Poland, Norway, the Netherlands, and Sweden from June 8, 2009, to June 23, 2014. INTERVENTIONS: Colonoscopy screening or no screening. MAIN OUTCOMES AND MEASURES: Participation in colonoscopy screening, cancer and adenoma yield, and participant experience. Study outcomes were compared by country and endoscopist. RESULTS: Of 31 420 eligible participants randomized to the colonoscopy group, 12 574 (40.0%) underwent screening. Participation rates were 60.7% in Norway (5354 of 8816), 39.8% in Sweden (486 of 1222), 33.0% in Poland (6004 of 18 188), and 22.9% in the Netherlands (730 of 3194) (P < .001). The cecum intubation rate was 97.2% (12 217 of 12 574), with 9726 participants (77.4%) not receiving sedation. Of the 12 574 participants undergoing colonoscopy screening, we observed 1 perforation (0.0...