Colorectal Cancer Screening in Norway – a pilot study
Article
|Last update
The Colorectal Cancer Screening Pilot was a pilot for the national screening programme for colorectal cancer – the Colorectal Cancer Screening Programme. The pilot project included 140,000 participants between 2012 and 2023. It compared two methods for early detection of colorectal cancer: a home test for blood in stool and sigmoidoscopy.
The pilot project was initiated by the Ministry of Health and Care Services and funded through the national budget. The planning and implementation were carried out by South-Eastern Norway Regional Health Authority and the Cancer Registry of Norway, in collaboration with the Norwegian Directorate of Health, Oslo University Hospital, Vestre Viken Hospital Trust, and Østfold Hospital Trust.
Colorectal Cancer in Norway
Norway has one of the highest rates of colorectal cancer in the world. Each year, around 4,500 men and women are diagnosed with the disease. Symptoms often appear late in the disease progression, when prognosis is uncertain or poor, and treatments such as radiation and chemotherapy have limited effect. Screening the population can help reduce mortality from colorectal cancer. Most countries in Europe have introduced or are planning to introduce colorectal cancer screening in line with EU recommendations.
Colorectal Cancer Screening
The pilot project began in April 2012 and included participants until 2018. A total of 140,000 men and women aged 50–74 living in Østfold, Akershus, and Buskerud were invited to participate. The last invitations were sent in August 2023.
There are several methods for screening colorectal cancer, but it is not yet clear which method is most effective from a public health perspective. This pilot was designed as a research study based on principles of comparative effectiveness research. Participants were randomly assigned to one of two screening methods: an immunochemical faecal occult blood test (iFOBT/FIT) or sigmoidoscopy. Both methods are well established but had not previously been directly compared. The aim of the pilot was to determine which method works best for the Norwegian population.
Two Screening Methods
Participants received an information leaflet and were invited to either iFOBT or sigmoidoscopy.
-
Immunochemical Faecal Occult Blood Test (iFOBT/FIT): This is a home test that detects invisible blood in the stool. Those offered this test received a sampling kit along with the invitation. Instructions for sample collection and return were included. Participants received their test results within three weeks. They were offered the test every two years, up to four times.
-
Sigmoidoscopy: This is an examination of the lower part of the bowel (rectum and sigmoid colon) using a thin, flexible tube. The doctor looks for small wart-like growths called polyps, which can be precursors to cancer. If polyps were detected, tissue samples were taken or the polyps were removed. Participants had to attend a screening centre for the procedure, which was performed only once. The last sigmoidoscopies in the project were carried out in spring 2018.
If blood was found in the stool sample or if sigmoidoscopy revealed possible precancerous changes, the participant was offered a colonoscopy (an examination of the entire colon). Approximately one in ten participants, regardless of method, received a test result that led to a recommendation for colonoscopy. Follow-up colonoscopies were performed at the pilot screening centres in Moss and Bærum.
As this was a research project and not a screening programme, strict protocols were followed regarding participant selection and study design. It was not possible to sign up or choose the screening method, but participation was, of course, voluntary.
The knowledge gained from the pilot has been essential in developing the national Colorectal Cancer Screening Programme, which became a nationwide service in January 2024. The main aim of the study is to compare the incidence and mortality of colorectal cancer in the two groups. Therefore, the project will continue until 2035.
Research Projects Related to the Pilot Study
In addition to the pilot itself, there are several ongoing research and supplementary studies linked to the project. These may have clinical relevance and contribute to improved healthcare services in the future.