Expected impact of introducing screening for colorectal cancer in Norway
It is well documented that screening using fecal occult blood testing or sigmoidoscopy reduces mortality from colorectal cancer. How large such a reduction in mortality due to colorectal cancer would be if such a screening programme was implemented in Norway is not clear.
- Issued/Revised: 2010
It is well documented that screening using fecal occult blood testing or sigmoidoscopy reduces mortality from colorectal cancer. How large such a reduction in mortality due to colorectal cancer would be if such a screening programme was implemented in Norway is not clear. Also, the impact of such a programme in terms of negative consequences is uncertain. Whether a screening programme for colorectal cancer can be expected to impact on the total mortality is debated.
The Norwegian Knowledge Centre for the Health Services was asked to review the following issues:
Which absolute health gains and challenges in terms of false positive test results and possible other negative consequences can be expected if a national screening programme for colorectal cancer is implemented in Norway?
What is the likely explanation as to why evidence of an effect on total mortality is lacking for screening programmes using fecal occult blood testing?
- A national, Norwegian screening using fecal occult blood testing or sigmoidoscopy can be expected to reduce the number of deaths due to colorectal cancer by between 50 and 300 per year
- If fecal occult blood testing is used, the majority of the positive teste will be false positive (in the order of 2,000-3,500 persons per year)
- Serious complications due to follow-up colonoscopies will occur – around 10 to 100 per year
- Some of these will be bowel-perforations
- The available evidence indicates that screening with sigmoidoscopy leads to a reduction in total mortality. Whether the same is the case for fecal occult blood testing is more uncertain.
- Results from clinical effectiveness evaluations of screening for colorectal cancer: rapid review
- Colorectal cancer screening – effect on mortality and incidence rate of colorectal cancer. Overview of documentation and international recommendations
- Primary prevention and screening in the health services