Tags:
Nordic
Publications
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Tengesdal, Stig; Molberg, Øyvind; Holme, Øyvind; Ghiasvand, Reza; Gran, Jan Tore & Myklebust, Geirmund
(2026).
Lifetime risk of malignancy in polymyalgia rheumatica: a population-based matched cohort study from southern Norway.
Rheumatology.
ISSN 1462-0324.
65(6).
doi:
10.1093/rheumatology/keag297.
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Botteri, Edoardo; Holme, Øyvind; Løberg, Magnus; Bretthauer, Michael; Kalager, Mette & Randel, Kristin Ranheim
[Show all 7 contributors for this article]
(2026).
Twenty-Three–Year Benefits of Sigmoidoscopy Screening for Colorectal Cancer A Randomized Trial.
Annals of Internal Medicine.
ISSN 0003-4819.
179(6),
p. 804–811.
doi:
10.7326/annals-25-05456.
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Background:
Meta-analyses of randomized trials have shown that sigmoidoscopy screening reduces colorectal cancer (CRC) incidence and death for 15 years.
Objective:
To report the benefits of sigmoidoscopy after 23 years.
Design:
Randomized controlled trial. (NORCCAP [Norwegian Colorectal Cancer Prevention], ClinicalTrials.gov: NCT00119912)
Setting:
Population of Oslo and Telemark County, Norway.
Participants:
Persons aged 50 to 64 years without CRC at randomization.
Intervention:
Screening with once-only sigmoidoscopy, with or without 1 fecal immunochemical test, or no screening.
Measurements:
Colorectal cancer incidence and death.
Results:
A total of 100 210 persons were randomly assigned, and 98 654 were included in intention-to-screen analyses: 20 552 in the screening group and 78 102 in the no-screening group. Participation with screening was 61.4% in men and 64.7% in women. In men, the 23-year cumulative risk for CRC was 4.3% in the screening group and 6.0% in the no-screening group, corresponding to a risk difference of −1.7 percentage points (95% CI, −2.2 to −1.2 percentage points). In women, the corresponding risks were 4.2% and 4.7%, yielding a risk difference of −0.5 percentage points (CI, −1.0 to −0.01 percentage points). In men, the 23-year cumulative risk for CRC death was 1.4% in the screening group and 2.2% in the no-screening group, corresponding to a risk difference of −0.8 percentage points (CI, −1.1 to −0.5 percentage points). In women, the corresponding risks were 1.3% and 1.4%, yielding a risk difference of −0.1 percentage points (CI, −0.3 to 0.1 percentage points). The effect was strongest for rectosigmoid cancer. The addition of fecal blood testing to sigmoidoscopy did not change screening benefits.
Limitation:
Follow-up through national registries.
Conclusion:
Offering sigmoidoscopy screening in Norway reduced CRC incidence more in men than in women and reduced CRC death only in men.
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Kaminski, Michal F; Kalager, Mette; Løberg, Magnus; Emilsson, Louise; Macios, Anna & Samy, Faye
[Show all 22 contributors for this article]
(2026).
Long-term effects of colonoscopy screening on colorectal cancer incidence and mortality: a multicountry, population-based randomised controlled trial.
The Lancet.
ISSN 0140-6736.
doi:
10.1016/s0140-6736(26)00508-8.
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Background
We previously reported the 10-year effects of colonoscopy screening on colorectal cancer incidence and mortality. Here, we report the effects after 13 years of follow-up.
Methods
In this multicountry, population-based randomised controlled trial, 84 583 men and women aged 55–64 years at enrolment from Norway, Poland, and Sweden were randomly allocated (1:2) to colonoscopy screening or no screening and analysed. The primary outcomes were colorectal cancer incidence and mortality after 10–15 years of follow-up in intention-to-screen analyses, with first analysis after 10 years, and repeated every other year or at longer intervals. This trial is registered with ClinicalTrials.gov, NCT00883792, and is ongoing.
Findings At 13 years of follow-up, colorectal cancer incidence was 375 colorectal cancers (1·46%) of 28 217 individuals in the screening group and 912 colorectal cancers (1·80%) of 56 366 individuals in the no-screening group. The risk ratio (RR) was 0·81 (95% CI 0·71–0·90) in intention-to-screen analyses and 0·55 (0·33–0·81) in per-protocol analyses. The risk for proximal colorectal cancer was 129 (0·51%) in the screening group versus 283 (0·56%) in the no-screening group (RR 0·91 [0·71–1·09]), and the risk for distal colorectal cancer was 224 (0·87%) in the screening group versus 563 (1·11%) in the no-screening group (RR 0·79 [0·65–0·89]; interaction p<0·0001). In men, the colorectal cancer risk was 214 (1·69%) of 14 154 in the screening group and 541 (2·19%) of 28 247 in the no-screening group (RR 0·77 [0·64 to –0·88]); in women, the risk was 161 (1·24%) of 14 063 in the screening group versus 371 (1·43%) of 28 119 in the no-screening group (RR 0·87 [0·70 to 1·02]; interaction p<0·0001). Colorectal cancer mortality was 106 (0·41%) of 28 217 in the screening group and 236 (0·47%) of 56 366 in the no-screening group (intention-to-screen RR 0·88 [0·68–1·08], per-protocol RR 0·70 [0·26–1·25]). The observed colorectal cancer mortality in the non-screening group (0·47%) was substantially lower than expected at the time of designing the trial (0·82%).
Interpretation
One colonoscopy significantly reduced colorectal cancer incidence but not mortality over 13 years. Colorectal cancer mortality was lower in both study groups than when the trial was designed.
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Julbø, Frida Marie Ihle; Henriksen, Audun Ljone; Pradhan, Manohar; Lindstrøm, Erika Kristina; Kostolomov, Ilyá & Oukrif, Dahmane
[Show all 21 contributors for this article]
(2026).
Reliable classification of polyps based on artificial intelligence: a development and validation study.
EClinicalMedicine.
93.
doi:
10.1016/j.eclinm.2026.103826.
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Background
The shortage of pathologists presents a significant bottleneck in delivering timely and accurate diagnoses. To address this challenge, we developed the POLyp Artificial Intelligence-based RISk classifier (POLARIS), a prescreening tool designed to assist pathologists in handling the increasing volume of colorectal biopsies.
Methods
Using 15,079 whole-slide images (WSIs) from 2993 patients in the UK bowel cancer screening program between 2014 and 2018 and the histological diagnoses as ground truth, POLARIS was developed applying the open-source foundation model H-optimus-0, multiple instance learning, and a training scheme designed to provide robust models. Each WSI was categorised into one of five classes based on the diagnosis, reflecting increasing risk of malignancy, and regrouped into two broader categories for clinical interpretation. One category includes only samples not requiring pathological review, specifically those classified as normal tissue or tubular adenomas with low-grade dysplasia (LGD). The second category includes all other types of polyps, which are polyps recommended for review by a pathologist. A prespecified validation protocol defined how a specific model should be evaluated on a geographically external dataset comprising 10,842 WSIs from Cheltenham General Hospital between 2008 and 2019 and acquired using two scanners, Leica Aperio AT2 and Hamamatsu NanoZoomer XR. After validation, three experienced pathologists independently assessed the cases in which model prediction differed most from clinical diagnosis and, blinded to model output, reached a consensus.
Findings
In the external validation, POLARIS correctly identified 98.94% (95% CI 96.92–99.78%) of polyps with high-grade dysplasia (HGD) and adenocarcinoma as POLARIS-positive, and correctly classified 83.04% (81.66–84.36%) of normal and tubular adenomas with LGD as POLARIS-negative. The overall balanced accuracy was 86.65% for this prespecified primary analysis. In the tuning set, balanced accuracy was 87.64%, the sensitivity for polyps with HGD and adenocarcinoma was 100% (95% CI 97.14–100), and the specificity for normal and tubular adenomas with LGD was 81.89% (79.94–83.70). POLARIS achieved an area under the receiver operating characteristic curve (AUROC) in external validation of 0.9449 (95% CI 0.9384–0.9507) for distinguishing normal and tubular adenomas with LGD from polyps recommended for review by a pathologist and 0.9788 (0.9718–0.9844) for polyps with HGD and adenocarcinoma cases specifically. The model predicted the same class for both scanners in 97.93% (97.49–98.32%) of the cases. In the review of selected cases, the pathologists agreed with the model and not the clinical diagnosis in 92.5% of the cases. Heatmaps highlighting regions where the model indicates high-risk features closely correlated with areas annotated by expert pathologists as high-risk.
Interpretation
POLARIS has the potential to enhance diagnostic workflows in colorectal pathology by reliably identifying high-risk lesions and highlighting high-risk regions while substantially reducing the number of slides requiring pathologist review.
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Iqbal, Nadia; Bhargava, Sameer; Hofvind, Solveig Sand-Hanssen; Farah, Khadra Samia; Holme, Øyvind & Botteri, Edoardo
[Show all 7 contributors for this article]
(2026).
Effect of reminder phone calls in the language of origin on colorectal cancer screening participation among immigrants in Norway: a randomised controlled trial.
The Lancet Regional Health - Europe.
63,
p. 1–10.
doi:
10.1016/j.lanepe.2026.101648.
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Background
The effect of providing oral information in immigrants’ language of origin on screening participation remains unclear. This study aimed to assess the effect of a reminder phone call in the language of origin combined with a reminder letter in Norwegian, compared to only a reminder letter in Norwegian, on participation in ColorectalScreen Norway among immigrants from Pakistan and Somalia.
Methods
We conducted a randomised controlled trial among individuals born in Pakistan or Somalia (age 55–56) who did not return a faecal immunochemical test (FIT) within six weeks after the kit was mailed. Individuals were randomised (1:1), to receive a reminder letter in Norwegian and a phone call in their language of origin (intervention) or solely the reminder letter (control). The primary outcome was participation in ColorectalScreen Norway, defined as return of the kit within 12 weeks after sending the reminder letter. ClinicalTrials.gov: NCT06324409.
Findings
We included 416 individuals (215 men and 201 women) during the period from March to October 2024: 217 in the intervention group and 199 in the control group. Overall participation was 24% (53/217) in the intervention group and 11% (22/199) in the control group (risk ratio 2·21 (95% confidence interval (CI) 1·40–3·49)). Participation among Pakistani immigrants was 30% (30/101) in the intervention group and 12% (12/101) in the control group (risk ratio 2·50 (95% CI 1·36–4·60)), and among Somali immigrants 20% (23/116) and 10% (10/98), respectively (risk ratio 1·94 (95% CI 0·97–3·88)) (pheterogeneity = 0·5110).
Interpretation
Reminder phone calls in the individuals’ language of origin doubled the participation rate among immigrants from Pakistan and Somalia in ColorectalScreen Norway, with consistent effects across both nationality groups. The results highlight the complexity and diversity of ensuring access to cancer screening for all and demonstrate the potential of oral information to reach immigrants.
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Rognstad, Øyvind Bakken; Botteri, Edoardo; Hoff, Geir Svein; Bretthauer, Michael; Nguyen, Dung-Hong & Schult, Anna Lisa
[Show all 8 contributors for this article]
(2026).
Use of claims data to identify adverse events after colonoscopy in a randomised colorectal cancer screening trial in Norway: a cross-sectional study.
BMJ Open.
16(1),
p. 1–8.
doi:
10.1136/bmjopen-2025-109883.
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Objectives Accurate identification of adverse events after colonoscopy is essential for quality assurance in colorectal cancer (CRC) screening. Review of medical records is labour intensive as adverse events are infrequent. The object of this study was to investigate the accuracy of claims data in identifying adverse events after colonoscopy in CRC screening.
Design Cross-sectional, retrospective.
Setting and participants Males and females aged 50–74 years were randomised to once-only sigmoidoscopy or biennial faecal immunochemical test in a CRC screening trial at two screening centres in Norway. Participants in the present study underwent follow-up colonoscopy from 2012 to April 2020 after initial positive screening test. We reviewed medical records for adverse events within 30 days following 11 205 colonoscopies.
Primary and secondary outcome measures The primary outcome of the study was to assess the sensitivity of claims data from the Norwegian Patient Registry to identify lower gastrointestinal bleeding using emergency contact International Statistical Classification of Diseases and Related Health Problems 10th Revision diagnostic code sets under two definitions: a stringent definition (codes explicitly identifying bleeding) and a broad definition (including suggestive codes). Secondary outcome measures included the sensitivity to identify perforation using a stringent and a broad definition. Additionally, we assessed whether incorporating procedure codes and non-emergency contacts improved accuracy.
Results 87 cases of lower gastrointestinal bleeding and eight perforations were confirmed. Sensitivity for bleeding differed between the centres (p<0.001). At centre 1, sensitivity was 48.6% (95% CI 31.9% to 65.6%) using the stringent and 89.2% (95% CI 74.6% to 97.0%) using the broad definition. At centre 2, sensitivity was 36.0% (95% CI 22.9% to 50.8%) and 50.0% (95% CI 35.5% to 64.5%), respectively. Combined sensitivity for perforation was 37.5% (95% CI 8.5% to 75.5%) using the stringent and 62.5% (95% CI 24.5% to 91.5%) using the broad definition. Adding procedure codes and non-emergency contacts slightly increased sensitivity but increased false positives.
Conclusions Use of claims data underestimated adverse event rates following colonoscopy. Difference in coding practice across hospitals underscores the need for standardised reporting in screening programmes. Trial registration number NCT01538550 .
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Olabintan, Olaolu; Halvorsen, Natalie Grace Mosteiro; Baddeley, Robin; Kudo, Shin Ei; Barua, Ishita & Misawa, Masashi
[Show all 21 contributors for this article]
(2025).
Environmental impact of computer-aided diagnosis in colonoscopy: A carbon footprint assessment of a prospective study cohort.
Endoscopy.
ISSN 0013-726X.
58(03),
p. 303–309.
doi:
10.1055/a-2717-8365.
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Background
The environmental impact of computer-aided diagnosis (CADx) in colonoscopy is unknown. The potential to reduce greenhouse gas emissions by limiting unnecessary polypectomies may be offset by emissions associated with CADx devices. We quantified and compared the carbon footprint of colonoscopy with and without CADx.
Methods
Life-cycle carbon emissions associated with endoscopic snares, polyp traps, histopathology, and CADx devices were estimated using life-cycle assessment software. The effect of CADx was estimated by the carbon dioxide equivalent (CO2e) emissions related to outcomes from a prospective cohort of patients who underwent colonoscopy with optical diagnosis under a leave-in-situ strategy (i.e. rectosigmoid polyps ≤5 mm predicted as non-neoplastic were not removed) with and without CADx assistance.
Results
We analyzed 1134 individuals (median age 67 years, 59% male) with 1716 colorectal polyps. Colonoscopy with CADx reduced the number of snares and polyp traps from 567 to 543 (difference: 24) and histopathology submissions from 1343 to 1278 (difference: 65). However, the total carbon footprint increased from 832 kg CO2e (95%CI 815 to 847) without CADx to 946 kg CO2e (95%CI 927 to 965) with CADx, corresponding to an absolute increase of 114 kg CO2e (95%CI 80 to 150) or 0.10 kg CO2e per colonoscopy.
Conclusion
Using CADx under a leave-in-situ strategy increased the environmental burden of colonoscopy.
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Tengesdal, Stig; Molberg, Øyvind; Holme, Øyvind; Gran, Jan Tore & Myklebust, Geirmund
(2025).
Mortality in polymyalgia rheumatica: a 38-year prospective population-based cohort study from Southern Norway.
Arthritis Research & Therapy.
ISSN 1478-6354.
27,
p. 1–9.
doi:
10.1186/s13075-025-03613-9.
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Abstract Background Robust long-term mortality data on patients with polymyalgia rheumatica (PMR) are lacking. The aim of this study was to determine all-cause mortality in isolated PMR using a large, population-based, inception cohort followed prospectively over a 38-year period. Methods Between 1987 and 1997, 337 incident cases of PMR and biopsy-proven GCA were included in a prospective, population-based inception cohort in Aust-Agder County, Norway. Diagnosis was ascertained clinically by a rheumatologist, with PMR cases meeting Bird`s criteria. Patients were followed until death or end of study on December 31st, 2024. Each case was matched by gender, age at inclusion, and residency with 15 population comparators drawn from the population registry in Norway. We assessed mortality and survival by standard mortality ratios (SMR) and the Kaplan-Meier method. Results A total of 274 patients with isolated PMR (66.1% female, mean age at diagnosis 71.9 years) and 63 patients with GCA (76.2% female, mean age at diagnosis 71.6 years) were included. By the end of the study, 96.4% of all patients were deceased. Mean follow-up time for all patients was 13.7 years, with a maximum of 35.3 years. For cases with isolated PMR, the overall SMR was 0.97 (95% confidence interval [CI] 0.85, 1.09), for men 0.77 (95% CI 0.62, 0.95), and for women 1.11 (95% CI 0.95, 1.28). For GCA, the overall SMR was 1.10 (95% CI 0.85, 1.40), with no gender difference. Conclusions In this comprehensive long-term follow-up study with nearly complete data on mortality, isolated PMR was not associated with increased mortality, reinforcing the view that it does not confer a higher mortality risk.
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Young, Jessica C.; Helsingen, Lise Mørkved; Refsum, Erle; Högdén, Amanda; Perrin, Vera & Løberg, Magnus
[Show all 20 contributors for this article]
(2025).
Temporal trends in characteristics and management of inflammatory bowel disease.
Scandinavian Journal of Gastroenterology.
ISSN 0036-5521.
60(5),
p. 421–429.
doi:
10.1080/00365521.2025.2478166.
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Background and aims: Inflammatory bowel disease (IBD) requires complex clinical management. Despite substantial advancements in endoscopy and in pharmacotherapies for patients with IBD, it remains unclear how these developments have influenced IBD incidence and clinical care. We aim to describe changes in diagnostic and therapeutic practices in IBD management.
Methods: All individuals diagnosed with IBD between 1987 and 2016 were identified from nationwide registries in Norway and Sweden. We performed detailed chart abstractions for a random sample of the cohort. We describe patient characteristics, disease extent, endoscopic practices, pathology diagnostics, pharmacological therapy and surgical management, stratifying by Crohn’s disease (CD) and ulcerative colitis [UC], comparing patients diagnosed before (pre-biologic period, 1987–1999), and after the introduction of biologic drugs (biologic period, 2000–2016).
Results: Chart abstraction was completed for 791 individuals (UC: 58.8%, Crohn’s disease: 40.2%, unclassified IBD: 1.0%). Comparing the biologic period to the pre-biologic period, we observed an increase in endoscopies after diagnosis, more frequent colonoscopies, and a decrease in colon resection rates. Among those diagnosed in 2007 or later compared with those diagnosed between 2000 and 2006, there was a higher treatment initiation rate of azathioprine, infliximab and adalimumab within 1 year after diagnosis.
Conclusions: Our findings suggest a shift towards more frequent endoscopy, increased use of immunosuppressants and biologics, and decreased colon resection rates in recent periods.
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Randel, Kristin Ranheim; Schult, Anna Lisa; Botteri, Edoardo; Nawaz, Mobina; Nguyen, Dung-Hong & Holme, Øyvind
[Show all 9 contributors for this article]
(2024).
Impact of inadequate bowel cleansing in sigmoidoscopy screening.
Scandinavian Journal of Gastroenterology.
ISSN 0036-5521.
59(8),
p. 1002–1009.
doi:
10.1080/00365521.2024.2364213.
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Background and study aims: Long-time follow-up of sigmoidoscopy screening trials has shown reduced incidence and mortality of colorectal cancer (CRC), but inadequate bowel cleansing may hamper efficacy. The aim of this study was to assess the impact of bowel cleansing quality in sigmoidoscopy screening.
Patients and methods: Individuals 50 to 74 years old who had a screening sigmoidoscopy in a population-based Norwegian, randomized trial between 2012 and 2019, were included in this cross-sectional study. The bowel cleansing quality was categorised as excellent, good, partly poor, or poor. The effect of bowel cleansing quality on adenoma detection rate (ADR) and referral to colonoscopy was evaluated by fitting multivariable logistic regression models.
Results: 35,710 individuals were included. The bowel cleansing at sigmoidoscopy was excellent in 20,934 (58.6%) individuals, good in 6580 (18.4%), partly poor in 7097 (19.9%) and poor in 1099 (3.1%). The corresponding ADRs were 17.0%, 16.6%, 14.5%, and 13.0%. C
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Bernklev, Linn; Nilsen, Jens Aksel; Augestad, Knut Magne; Holme, Øyvind & Pilonis, Nastazja Dagny
(2024).
Management of non-curative endoscopic resection of T1 colon cancer.
Baillière's Best Practice & Research Clinical Gastroenterology.
ISSN 1521-6918.
68.
doi:
10.1016/j.bpg.2024.101891.
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Endoscopic resection techniques enable en-bloc resection of T1 colon cancers. A complete removal of T1 colon cancer can be considered curative when histologic examination of the specimens shows none of the high-risk factors for lymph nodes metastases. Criteria predicting lymph nodes metastases include deep submucosal invasion, poor differentiation, lymphovascular invasion, and high-grade tumor budding. In these cases, complete (R0), local endoscopic resection is considered sufficient as negligible risk of lymph nodes metastases does not outweigh morbidity and mortality associated with surgical resection. Challenges arise when endoscopic resection is incomplete (RX/R1) or high-risk histological features are present. The risk of lymph node metastasis in T1 CRC ranges from 1% to 36.4%, depending on histologic risk factors. Presence of any risk factor labels the patient “high risk,” warranting oncologic surgery with mesocolic lymphadenectomy. However, even if 70%–80% of T1-CRC patients are classified as high-risk, more than 90% are without lymph node involvement after oncological surgery. Surgical overtreatment in T1 CRC is a challenge, requiring a balance between oncologic safety and minimizing morbidity/mortality. This narrative review explores the landscape of managing non-curative T1 colon cancer, focusing on the choice between advanced endoscopic resection techniques and surgical interventions. We discuss surveillance strategies and shared decision-making, emphasizing the importance of a multidisciplinary approach.
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Rognstad, Øyvind Bakken; Botteri, Edoardo; Hoff, Geir Svein; Bretthauer, Michael; Gulichsen, Elisabeth Haagensen & Frigstad, Svein Oskar
[Show all 8 contributors for this article]
(2024).
Adverse events after colonoscopy in a randomised colorectal cancer screening trial.
BMJ open gastroenterology.
11(1).
doi:
10.1136/bmjgast-2024-001471.
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Objective: Colonoscopy-related adverse events increase the burden of colorectal cancer (CRC) screening. This cross-sectional study evaluates adverse events during and after colonoscopy in a large, randomised CRC screening trial in Norway comparing sigmoidoscopy to immunochemical testing for faecal blood.
Methods: We included all individuals who underwent colonoscopy at two screening centres between 2012 and 2020. From medical records, we retrieved data on adverse events during and within 30 days after colonoscopy and classified them according to the American Society for Gastrointestinal Endoscopy lexicon for endoscopic adverse events. Multivariable logistic regression models were fitted to identify risk factors for adverse events.
Results: Of the 10 244 included individuals, 242 (2.4%) had at least one adverse event that was possibly, probably, or definitively related to the colonoscopy. 188 (1.8%) had mild adverse events, 50 (0.49%) had moderate, 3 (0.03%) had severe, and 1 had a fatal adverse event. The m
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Randel, Kristin Ranheim; Botteri, Edoardo; Lange, Thomas de; Schult, Anna Lisa; Eskeland, Sigrun Losada & El-Safadi, Badboni
[Show all 11 contributors for this article]
(2024).
Performance of Faecal Immunochemical Testing for Colorectal Cancer Screening at Varying Positivity Thresholds.
Alimentary Pharmacology and Therapeutics.
ISSN 0269-2813.
61(1),
p. 122–131.
doi:
10.1111/apt.18314.
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Background: The positivity thresholds of faecal immunochemical testing (FIT) in colorectal cancer (CRC) screening vary between countries.
Aims: To explore the trade-off between colonoscopies performed, adverse events and lesions detected at different FIT thresholds in a Norwegian CRC screening trial.
Methods: We included first participation in biennial FIT screening for 47,265 individuals aged 50-74 years. Individuals with FIT > 15 μg Hb/g faeces were referred for colonoscopy. We estimated the number of colonoscopies, adverse events, screen-detected CRCs, advanced adenomas and serrated lesions expected at FIT thresholds currently or recently used in other European countries ranging between 20 and 150 μg/g.
Results: At the 15 μg/g threshold (Norway), 3705 participants underwent colonoscopy, of whom 203 had CRC, 1119 advanced adenomas and 256 advanced serrated lesions. Using a 47 μg/g threshold, 1826 (49.3%) individuals would have undergone colonoscopy, and 154 (75.9%) would have been diagnosed with CRC, 702
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Juul, Frederik Emil; Cross, Amanda J.; Schoen, Robert E.; Senore, Carlo; Pinsky, Paul F. & Miller, Eric A.
[Show all 17 contributors for this article]
(2024).
Effectiveness of Colonoscopy Screening vs Sigmoidoscopy Screening in Colorectal Cancer.
JAMA Network Open.
7(2).
doi:
10.1001/jamanetworkopen.2024.0007.
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Importance: Randomized clinical screening trials have shown that sigmoidoscopy screening reduces colorectal cancer (CRC) incidence and mortality. Colonoscopy has largely replaced sigmoidoscopy for CRC screening, but long-term results from randomized trials on colonoscopy screening are still lacking.
Objective: To estimate the additional screening benefit of colonoscopy compared with sigmoidoscopy.
Design, setting, and participants: This comparative effectiveness simulation study pooled data on 358 204 men and women randomly assigned to sigmoidoscopy screening or usual care in 4 randomized sigmoidoscopy screening trials conducted in Norway, Italy, the US, and UK with inclusion periods in the years 1993 to 2001. The primary analysis of the study was conducted from January 19 to December 30, 2021.
Intervention: Invitation to endoscopic screening.
Main outcomes and measures: Primary outcomes were CRC incidence and mortality. Using pooled 15-year follow-up data, colonoscopy screening effectiveness was estimate
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Schult, Anna Lisa; Hoff, Geir Svein; Holme, Øyvind; Botteri, Edoardo; Seip, Birgitte Karen Berggreen & Randel, Kristin Ranheim
[Show all 12 contributors for this article]
(2023).
Colonoscopy quality improvement after initial training: A cross-sectional study of intensive short-term training.
Endoscopy International Open.
11(1),
p. E117–E127.
doi:
10.1055/a-1994-6084.
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Background and study aims High-quality is crucial for the effectiveness of colonoscopy and can be achieved by high-quality training and verified with assessment of key performance indicators (KPIs) for colonoscopy such as cecum intubation rate (CIR), adenoma detection rate (ADR) and adequate polyp resection. Typically, trainees achieve adequate CIR after 275 procedures, but little is known about learning curves for KPIs after initial training. Methods This cross-sectional study includes work-up colonoscopies after a positive screening test with fecal occult blood testing (FIT) or sigmoidoscopy, performed by either trainees after 300 training colonoscopies or by consultants. Outcome measures were KPIs. We assessed inter-endoscopist variation in trainees and learning curves for trainees as a group. We also compared KPIs for trainees and consultants as a group. Results Data from 6,655 colonoscopies performed by 21 trainees and 921 colonoscopies performed by 17 consultants were included. Most trainees achieved target standards for main KPIs. With time, trainees shortened cecum intubation time and withdrawal time without decreasing their ADR, reduced the proportion of painful colonoscopies, and increased the adequate polyp resection rate (all P < 0.01). Compared to consultants, trainees had higher CIR (97.7 % vs. 96.3 %, P = 0.02), ADR after positive FIT (57.6 % vs. 50.3 %, P < 0.01), and proximal ADR after sigmoidoscopy screening (41.1 % vs. 29.8 %; P < 0.01), higher adequate polyp resection rate (94.9 % vs. 93.1 %, P = 0.01) and fewer serious adverse events (0.65 % vs. 1.41 %, P = 0.02). Conclusions Trainees performed high-quality colonoscopies and achieved international target standards. Several KPIs continuously improved after initial training. Trainees outperformed consultants on several KPIs.
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Nafisi, Sara; Randel, Kristin Ranheim; Støer, Nathalie Charlotte; Veierød, Marit Bragelien; Hoff, Geir Svein & Holme, Øyvind
[Show all 8 contributors for this article]
(2023).
Association between use of low-dose aspirin and detection of colorectal polyps and cancer in a screening setting.
Digestive and Liver Disease.
ISSN 1590-8658.
55,
p. 1126–1132.
doi:
10.1016/j.dld.2023.01.156.
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Background: The possible protective effect of aspirin on risk of colorectal cancer (CRC) is still highly debated.
Methods: We used data from Bowel Cancer Screening in Norway, a trial randomizing individuals from general population, aged 50-74 years, to flexible sigmoidoscopy or faecal immunochemical test (FIT), to study the association between aspirin use and detection of CRC and two CRC precursors: adenomas and advanced serrated lesions (ASL). Prescriptions of low-dose aspirin were obtained from Norwegian prescription database. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Among 64,889 screening participants (24,159 sigmoidoscopy, 40,730 FIT), 314 (0.5%) had CRC, 6,208 (9.6%) adenoma and 659 (1.0%) ASL. Overall and short-term use (<3 years) of low-dose aspirin, versus no use, were not associated with any colorectal lesion. Long-term use (≥3 years) was associated with lower detection of CRC (overall OR 0.66, 95%CI 0.46-0.93; sigmoidoscopy: 0.56, 0.33-0.97; FIT: 0.72, 0.45-1.15), adenomas in sigmoidoscopy arm (overall OR 0.95, 95%CI 0.87-1.03; sigmoidoscopy: 0.89, 0.80-0.99; FIT: 1.03, 0.89-1.18), but not ASLs. We did not observe significant differences in the effect of aspirin according to the location of colorectal lesions.
Conclusion: Our results suggest that long-term use of aspirin might have a protective effect against adenomas and colorectal cancer, but not ASLs.
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Bhargava, Sameer; Botteri, Edoardo; Berthelsen, Mona; Iqbal, Nadia; Randel, Kristin Ranheim & Holme, Øyvind
[Show all 7 contributors for this article]
(2023).
Lower participation among immigrants in colorectal cancer screening in Norway.
Frontiers in Public Health.
11.
doi:
10.3389/fpubh.2023.1254905.
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Introduction Organized cancer screening programs should be equally accessible for all groups in society. We assessed differences in participation in colorectal cancer (CRC) screening among different immigrant groups. Methods Between 2012 and 2019, 140,000 individuals aged 50 to 74 years were randomly invited to sigmoidoscopy or repeated faecal immunochemical test (FIT) in a CRC screening trial. In this study, we included 46,919 individuals invited to sigmoidoscopy and 70,018 invited to the first round of FIT between 2012 and 2017. We examined difference in participation between non-immigrants and immigrants, and within different immigrant groups by geographic area of origin, using logistic regression models, adjusted for several sociodemographic factors and health factors. Results In total, we included 106,695 non-immigrants and 10,242 immigrants. The participation rate for FIT was 60% among non-immigrants, 58% among immigrants from Western countries and 37% among immigrants from non-Western countries. The participation rate for sigmoidoscopy was 53% among non-immigrants, 48% among immigrants from Western countries and 23% among immigrants from non-Western countries. Compared to non-immigrants, multivariate adjusted odds ratio for non-participation in FIT screening was 1.13 (95% confidence interval 1.04–1.23) and 1.82 (1.69–1.96) for immigrants from Western and non-Western countries. The corresponding numbers in sigmoidoscopy screening were 1.34 (1.21–1.48) and 2.83 (2.55–3.14). The lowest participation was observed in immigrants from Eastern Europe, Northern Africa and Western Asia, and South-Central Asia. Conclusion Participation in CRC screening in Norway was particularly low among non-Western immigrants, which could put them at increased risk for late stage diagnosis of CRC. Participation was lower in sigmoidoscopy screening than in FIT screening, especially among immigrants from non-Western countries.
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Jodal, Henriette C.; Wieszczy, Paulina; Klotz, Dagmar; Herfindal, Magnhild; Barua, Ishita & Tag, Petter
[Show all 13 contributors for this article]
(2023).
A Comparison of Risk Classification Systems of Colorectal Adenomas: A Case-Cohort Study.
Gastroenterology.
ISSN 0016-5085.
165,
p. 483–491.
doi:
10.1053/j.gastro.2023.04.028.
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Background & Aims Because post-polypectomy surveillance uses a growing proportion of colonoscopy capacity, more targeted surveillance is warranted. We therefore compared surveillance burden and cancer detection using 3 different adenoma classification systems. Methods In a case-cohort study among individuals who had adenomas removed between 1993 and 2007, we included 675 individuals with colorectal cancer (cases) diagnosed a median of 5.6 years after adenoma removal and 906 randomly selected individuals (subcohort). We compared colorectal cancer incidence among high- and low-risk individuals defined according to the traditional (high-risk: diameter ≥10 mm, high-grade dysplasia, villous growth pattern, or 3 or more adenomas), European Society of Gastrointestinal Endoscopy (ESGE) 2020 (high-risk: diameter ≥10 mm, high-grade dysplasia, or 5 or more adenomas), and novel (high-risk: diameter ≥20 mm or high-grade dysplasia) classification systems. For the different classification systems, we calculated the number of individuals recommended frequent surveillance colonoscopy and estimated number of delayed cancer diagnoses. Results Four hundred and thirty individuals with adenomas (52.7%) were high risk based on the traditional classification, 369 (45.2%) were high risk based on the ESGE 2020 classification, and 220 (27.0%) were high risk based on the novel classification. Using the traditional, ESGE 2020, and novel classifications, the colorectal cancer incidences per 100,000 person-years were 479, 552, and 690 among high-risk individuals, and 123, 124, and 179 among low-risk individuals, respectively. Compared with the traditional classification, the number of individuals who needed frequent surveillance was reduced by 13.9% and 44.2%, respectively, and 1 (3.4%) and 7 (24.1%) cancer diagnoses were delayed using the ESGE 2020 and novel classifications. Conclusions Using the ESGE 2020 and novel risk classifications will substantially reduce resources needed for colonoscopy surveillance after adenoma removal.
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Holme, Øyvind; Kalager, Mette; Bretthauer, Michael; Adami, Hans Olov; Helsingen, Lise Mørkved & Løberg, Magnus
(2023).
Ongoing Trials Will Not Determine the Comparative Effectiveness of Colorectal Cancer Screening Tests.
Gastroenterology.
ISSN 0016-5085.
164(6),
p. 856–860.
doi:
10.1053/j.gastro.2020.02.071.
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Juul, Frederik Emil; Garborg, Kjetil Kjeldstad; Nesbakken, Philip Eugen; Løberg, Magnus; Wieszczy, Paulina & Cubiella, Joaquín
[Show all 19 contributors for this article]
(2022).
Rates of repeated colonoscopies to clean the colon from low-risk and high-risk adenomas: Results from the EPoS trials.
Gut.
ISSN 0017-5749.
doi:
10.1136/gutjnl-2022-327696.
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Objective High-quality colonoscopy (adequate bowel preparation, whole-colon visualisation and removal of all neoplastic polyps) is a prerequisite to start polyp surveillance, and is ideally achieved in one colonoscopy. In a large multinational polyp surveillance trial, we aimed to investigate clinical practice variation in number of colonoscopies needed to enrol patients with low-risk and high-risk adenomas in polyp surveillance.
Design We retrieved data of all patients with low-risk adenomas (one or two tubular adenomas <10 mm with low-grade dysplasia) and high-risk adenomas (3–10 adenomas, ≥1 adenoma ≥10 mm, high-grade dysplasia or villous components) in the European Polyp Surveillance trials fulfilling certain logistic and methodologic criteria. We analysed variations in number of colonoscopies needed to achieve high-quality colonoscopy and enter polyp surveillance by endoscopy centre, and by endoscopists who enrolled ≥30 patients.
Results The study comprised 15 581 patients from 38 endoscopy centres in five European countries; 6794 patients had low-risk and 8787 had high-risk adenomas. 961 patients (6.2%, 95% CI 5.8% to 6.6%) underwent two or more colonoscopies before surveillance began; 101 (1.5%, 95% CI 1.2% to 1.8%) in the low-risk group and 860 (9.8%, 95% CI 9.2% to 10.4%) in the high-risk group. Main reasons were poor bowel preparation (21.3%) or incomplete colonoscopy/polypectomy (14.4%) or planned second procedure (27.8%). Need of repeat colonoscopy varied between study centres ranging from 0% to 11.8% in low-risk adenoma patients and from 0% to 63.9% in high-risk adenoma patients. On the second colonoscopy, the two most common reasons for a repeat (third) colonoscopy were piecemeal resection (26.5%) and unspecified reason (23.9%).
Conclusion There is considerable practice variation in the number of colonoscopies performed to achieve complete polyp removal, indicating need for targeted quality improvement to reduce patient burden.
Trial registration number NCT02319928.
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Knudsen, Markus Dines; Kværner, Ane Sørlie; Botteri, Edoardo; Holme, Øyvind; Hjartåker, Anette & Song, Mingyang
[Show all 10 contributors for this article]
(2022).
Lifestyle predictors for inconsistent participation to fecal based colorectal cancer screening.
BMC Cancer.
22(172).
doi:
10.1186/s12885-022-09287-9.
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Background: Consistent participation in colorectal cancer (CRC) screening with repeated fecal immunochemical test (FIT) is important for the success of the screening program. We investigated whether lifestyle risk factors for CRC were related to inconsistent participation in up to four rounds of FIT-screening.
Method: We included data from 3,051 individuals who participated in up to four FIT-screening rounds and returned a lifestyle questionnaire. Using logistic regression analyses, we estimated associations between smoking habits, body mass index (BMI), physical activity, alcohol consumption, diet and a healthy lifestyle score (from least favorable 0 to most favorable 5), and inconsistent participation (i.e. not participating in all rounds of eligible FIT screening invitations).
Results: Altogether 721 (24%) individuals were categorized as inconsistent participants Current smoking and BMI ≥30 kg/m2 were associated with inconsistent participation; odds ratios (ORs) and 95% confidence intervals (CIs) were 1.54 (1.21-2.95) and 1.54 (1.20-1.97), respectively. A significant trend towards inconsistent participation by a lower healthy lifestyle score was observed (p
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Botteri, Edoardo; Hoff, Geir; Randel, Kristin Ranheim; Holme, Øyvind; Lange, Thomas de & Bernklev, Tomm
[Show all 16 contributors for this article]
(2022).
Characteristics of nonparticipants in a randomised colorectal cancer screening trial comparing sigmoidoscopy and faecal immunochemical testing.
International Journal of Cancer.
ISSN 0020-7136.
151(3),
p. 361–371.
doi:
10.1002/ijc.34025.
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Public health systems should guarantee universal access to health care services, including cancer screening. We assessed whether certain population subgroups were underrepresented among participants in colorectal cancer screening with sigmoidoscopy and faecal immunochemical testing (FIT). Between 2012 and 2019, about 140 000 individuals aged 50 to 74 years were randomly invited to once-only sigmoidoscopy or first round of FIT screening. Our study included 46 919 individuals invited to sigmoidoscopy and 70 019 to FIT between 2012 and 2017. We used logistic regression models to evaluate if demographic and socioeconomic factors and use of certain drugs were associated with participation. Twenty-four thousand one hundred and fifty-nine (51.5%) individuals attended sigmoidoscopy and 40 931 (58.5%) FIT screening. Male gender, young age, low education and income, being retired or unemployed, living alone, being an immigrant, long driving time to screening centre, and use of antidiabetic and psychotropic drugs were associated with low participation in both screening groups. Many of these factors also predicted low acceptance of colonoscopy after positive FIT. While male gender, young age and living alone were more strongly associated with nonparticipation in FIT than sigmoidoscopy, low education and income, being retired or immigrant and long driving time were more strongly associated with nonparticipation in sigmoidoscopy than FIT. In conclusion, participation was lower in sigmoidoscopy than FIT. Predictors of nonparticipation were similar between arms. However, low socioeconomic status, being an immigrant and long driving time affected participation more in sigmoidoscopy screening, suggesting that FIT may guarantee more equal access to screening services than sigmoidoscopy.
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Juul, Frederik Emil; Cross, Amanda J.; Schoen, Robert E.; Senore, Carlo; Pinsky, Paul & Miller, Eric
[Show all 17 contributors for this article]
(2022).
15-Year Benefits of Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality : A Pooled Analysis of Randomized Trials.
Annals of Internal Medicine.
ISSN 0003-4819.
175(11),
p. 1525–1533.
doi:
10.7326/M22-0835.
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Background: The effectiveness of screening for colorectal cancer (CRC) by sex and age in randomized trials is uncertain.
Objective: To evaluate the 15-year effect of sigmoidoscopy screening on CRC incidence and mortality.
Design: Pooled analysis of 4 large-scale randomized trials of sigmoidoscopy screening.
Setting: Norway, the United States, the United Kingdom, and Italy.
Participants: Women and men aged 55 to 64 years at enrollment.
Intervention: Sigmoidoscopy screening.
Measurements: Primary end points were cumulative incidence rate ratio (IRR) and mortality rate ratio (MRR) and rate differences after 15 years of follow-up comparing screening versus usual care in intention-to-treat analyses. Stratified analyses were done by sex, cancer site, and age at screening.
Results: Analyses comprised 274 952 persons (50.7% women), 137 493 in the screening and 137 459 in the usual care group. Screening attendance was 58% to 84%. After 15 years, the rate difference for CRC incidence was 0.51 cases (95% CI, 0.40 to 0.63 cases) per 100 persons and the IRR was 0.79 (CI, 0.75 to 0.83). The rate difference for CRC mortality was 0.13 deaths (CI, 0.07 to 0.19 deaths) per 100 persons, and the MRR was 0.80 (CI, 0.72 to 0.88). Women had less benefit from screening than men for CRC incidence (IRR for women, 0.84 [CI, 0.77 to 0.91]; IRR for men, 0.75 [CI, 0.70 to 0.81]; P = 0.032 for difference) and mortality (MRR for women, 0.91 [CI, 0.77 to 1.17]; MRR for men, 0.73 [CI, 0.64 to 0.83]; P = 0.025 for difference). There was no statistically significant difference in screening effect between persons aged 55 to 59 years and those aged 60 to 64 years.
Limitation: Data from the U.K. trial were less granular because of privacy regulations.
Conclusion: This pooled analysis of all large randomized trials of sigmoidoscopy screening demonstrates a significant and sustained effect of sigmoidoscopy on CRC incidence and mortality for 15 years.
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Kirkøen, Benedicte; Berstad, Paula; Hoff, Geir; Bernklev, Tomm; Randel, Kristin Ranheim & Holme, Øyvind
[Show all 9 contributors for this article]
(2022).
Type and Severity of Mental Illness and Participation in Colorectal Cancer Screening.
American Journal of Preventive Medicine.
ISSN 0749-3797.
64(1),
p. 76–85.
doi:
10.1016/j.amepre.2022.08.011.
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Introduction: The effectiveness of colorectal cancer screening programs depends on the participation rate. This study examined the association between type and severity of mental illness and colorectal cancer screening participation.
Methods: Between 2012 and 2017, a total of 46,919 individuals were invited to sigmoidoscopy screening in Norway, and 70,019 were invited to fecal immunochemical testing. In 2022, logistic regression was used to evaluate the association between the use of antipsychotics, anxiolytics, hypnotics, and antidepressants in the year preceding the screening invitation and screening participation, adjusted for demographic and socioeconomic factors. Defined daily doses of individual drugs were used to assess dose‒response relationships.
Results: Overall, 19.2% (24.8% of women, 13.4% of men) of all invitees used at least 1 psychotropic medication. Nonparticipation in the 2 arms combined was associated with the use of anxiolytics (60.7% in users vs 43.2% in nonusers; OR=1.53; 95% CI=1.45, 1.62) and antipsychotics (64.3% vs 43.8%; OR=1.41; 95% CI=1.30, 1.53) and increased with higher doses for both drugs. Hypnotics and antidepressants were only weakly associated with nonparticipation in higher doses. Participation rates were 57.3%, 52.3%, 42.9%, and 35.4% in those prescribed 0, 1, 2, and 3-4 classes of psychotropic medications, respectively. The associations between the use of psychotropic medications and nonparticipation were similar for the 2 screening tests.
Conclusions: These findings show significant disparities in colorectal cancer screening participation for individuals with mental illness, independent of the screening method. Moreover, screening participation varied depending on the type and severity of mental illness. Targeted interventions are warranted to ensure that people with mental illness are supported to access the benefits of colorectal cancer screening.
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Berthelsen, Mona; Berstad, Paula; Randel, Kristin Ranheim; Hoff, Geir; Natvig, Erik & Holme, Øyvind
[Show all 7 contributors for this article]
(2022).
The impact of driving time on participation in colorectal cancer screening with sigmoidoscopy and faecal immunochemical blood test.
Cancer Epidemiology.
ISSN 1877-7821.
80.
doi:
10.1016/j.canep.2022.102244.
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Background: High participation rates are important for a colorectal cancer (CRC) screening programme to be effective. Having a long travelling distance to screening centres may impede participation.
Methods: We analysed the association between driving time from home address to screening centre and participation among individuals invited to screening with faecal immunochemical test (FIT) (n = 68,624) or sigmoidoscopy (n = 46,076) in a randomized trial in Norway in 2012-17. Two screening centres were involved. We fitted multiple logistic regression models, adjusted for demographic, socioeconomic and health characteristics, and reported odds ratios (OR) with 95% confidence intervals (CI).
Results: Participation rates were 58.9 % (n = 40,445) for FIT and 51.9 % (n = 23,911) for sigmoidoscopy. In sigmoidoscopy, participation was 56.9 % and 47.9 % in those living < 20 and > 60 min by car from the screening centres, respectively. For each 10 min driving time increase, OR for participating in sigmoidoscopy screening was 0.93 (95 % CI 0.91-0.95). There was a significant difference between the two screening centres (p-value for heterogeneity <0.001). Participation in FIT screening were 61.2 % and 57.1 % in those with < 20 and > 60 min driving time, respectively, and the OR was 0.98 (95 % CI 0.96-0.99) for each 10 min increase (heterogeneity between screening methods, P-value <0.001). Among those with a positive FIT, compliance to colonoscopy was higher in those living < 20 compared to > 60 min from the centres (95.1 % vs. 92.9 %, respectively, OR 0.86; 95 % CI 0.77-0.93 for each 10 min increase).
Conclusions: Driving time to screening centre was a significant predictor of participation, mainly in sigmoidoscopy. There were local differences in the impact of driving time on participation. Driving time also affected compliance to colonoscopy after a positive FIT. When planning a CRC screening programme, one should consider offering people living far from screening sites special assistance to facilitate their participation.
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Pedersen, Ina Borgenheim; Rawa-Goleblewska, Anna; Calderwood, Audrey H.; Brix, Lone D.; Grode, Louise B. & Botteri, Edoardo
[Show all 17 contributors for this article]
(2022).
Complete Polyp Resection with Cold versus Hot snare Polypectomy for Polyps sized 4-9 mm: A randomized controlled trial.
Endoscopy.
ISSN 0013-726X.
54(10),
p. 961–969.
doi:
10.1055/a-1734-7952.
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Background: Endoscopic screening with polypectomy reduces the incidence of colorectal cancer (CRC). Incomplete polyp removal may attenuate the effect of screening. This randomized trial compared cold snare polypectomy (CSP) with hot snare polypectomy (HSP) in terms of complete polyp resection.
Methods: We included patients ≥ 40 years of age at eight hospitals in four countries who had at least one non-pedunculated polyp of 4-9 mm detected at colonoscopy. Patients were randomized 1:1 to CSP or HSP. Biopsies from the resection margins were obtained systematically after polypectomy in both groups. We hypothesized that CSP would be non-inferior to HSP, with a non-inferiority margin of 5 %. Logistic regression models were fitted to identify the factors explaining incomplete resection.
Results: 425 patients, with 601 polyps, randomized to either CSP or HSP were included in the analysis. Of 318 polyps removed by CSP and 283 polyps removed by HSP, 34 (10.7 %) and 21 (7.4 %) were incompletely resected, respectively, with an adjusted risk difference of 3.2 % (95 %CI -1.4 % to 7.8 %). There was no difference between the groups in terms of post-polypectomy bleeding, perforation, or abdominal pain. Independent risk factors for incomplete removal were serrated histology (odds ratio [OR] 3.96; 95 %CI 1.63 to 9.66) and hyperplastic histology (OR 2.52; 95 %CI 1.30 to 4.86) in adjusted analyses.
Conclusion: In this randomized trial, non-inferiority for CSP could not be demonstrated. Polyps with serrated histology are more prone to incomplete resection compared with adenomas. CSP can be used safely for small polyps in routine colonoscopy practice.
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Bretthauer, Michael; Løberg, Magnus; Wieszczy, Paulina; Kalager, Mette; Emilsson, Louise & Garborg, Kjetil Kjeldstad
[Show all 21 contributors for this article]
(2022).
Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death.
New England Journal of Medicine.
ISSN 0028-4793.
387(17),
p. 1547–1556.
doi:
10.1056/NEJMoa2208375.
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Background: Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear.
Methods: We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio to either receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause.
Results: Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden - 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93). The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95% CI, 270 to 1429). The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04).
Conclusions: In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening. (Funded by the Research Council of Norway and others; NordICC ClinicalTrials.gov number, NCT00883792.).
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Schult, Anna Lisa; Botteri, Edoardo; Hoff, Geir; Holme, Øyvind; Bretthauer, Michael & Randel, Kristin Ranheim
[Show all 13 contributors for this article]
(2021).
Women require routine opioids to prevent painful colonoscopies: a randomised controlled trial.
Scandinavian Journal of Gastroenterology.
ISSN 0036-5521.
56(12),
p. 1480–1489.
doi:
10.1080/00365521.2021.1969683.
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Background: Women are at high risk for painful colonoscopy. Pain, but also sedation, are barriers to colorectal cancer (CRC) screening participation. In a randomised controlled trial, we compared on-demand with pre-colonoscopy opioid administration to control pain in women at CRC screening age.
Methods: Women, aged 55-79 years, attending colonoscopy at two Norwegian endoscopy units were randomised 1:1:1 to (1) fentanyl on-demand, (2) fentanyl prior to colonoscopy, or (3) alfentanil on-demand. The primary endpoint was procedural pain reported by the patients on a validated four-point Likert scale and further dichotomized for the study into painful (moderate or severe pain) and non-painful (slight or no pain) colonoscopy. Secondary endpoints were: willingness to repeat colonoscopy, adverse events, cecal intubation time and rate, and post-procedure recovery time.
Results: Between June 2017 and May 2020, 183 patients were included in intention-to-treat analyses in the fentanyl on-demand group, 177 in the fentanyl prior to colonoscopy group, and 179 in the alfentanil on-demand group. Fewer women receiving fentanyl prior to colonoscopy reported a painful colonoscopy compared to those who were given fentanyl on-demand (25.2% vs. 44.1%, p
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Hoff, Geir; Botteri, Edoardo; Huppertz-Hauss, Gert; Kvamme, Jan-Magnus; Holme, Øyvind & Aabakken, Lars
[Show all 13 contributors for this article]
(2021).
The effect of train-the-colonoscopy-trainer course on colonoscopy quality indicators.
Endoscopy.
ISSN 0013-726X.
53(12),
p. 1229–1234.
doi:
10.1055/a-1352-4583.
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Background: Systematic training in colonoscopy is highly recommended; however, we have limited knowledge of the effects of "training-the-colonoscopy-trainer" (TCT) courses. Using a national quality register on colonoscopy performance, we aimed to evaluate the effects of TCT participation on defined quality indicators.
Methods: This observational study compared quality indicators (pain, cecal intubation, and polyp detection) between centers participating versus not participating in a TCT course. Nonparticipating centers were assigned a pseudoparticipating year to match their participating counterparts. Results were compared between first year after and the year before TCT (pseudo)participation. Time trends up to 5 years after TCT (pseudo)participation were also compared. Generalized estimating equation models, adjusted for age, sex, and bowel cleansing, were used.
Results: 11 participating and 11 nonparticipating centers contributed 18 555 and 10 730 colonoscopies, respectively. In participating centers, there was a significant increase in detection of polyps ≥ 5 mm, from 26.4 % to 29.2 % (P = 0.035), and reduction in moderate/severe pain experienced by women, from 38.2 % to 33.6 % (P = 0.043); no significant changes were found in nonparticipating centers. Over 5 years, 20 participating and 18 nonparticipating centers contributed 85 691 and 41 569 colonoscopies, respectively. In participating centers, polyp detection rate increased linearly (P = 0.003), and pain decreased linearly in women (P = 0.004). Nonparticipating centers did not show any significant time trend during the study period.
Conclusions: Participation in a TCT course improved polyp detection rates and reduced pain experienced by women. These effects were maintained during a 5-year follow-up.
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Schult, Anna Lisa; Botteri, Edoardo; Hoff, Geir; Randel, Kristin Ranheim; Dalén, Eirin & Eskeland, Sigrun Losada
[Show all 8 contributors for this article]
(2021).
Detection of cancers and advanced adenomas in asymptomatic participants in colorectal cancer screening: a cross-sectional study.
BMJ Open.
11(7).
doi:
10.1136/bmjopen-2020-048183.
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Objectives: To assess detection rates for colorectal cancer (CRC) and advanced adenomas in asymptomatic CRC screening participants and bowel symptoms in association with CRC and advanced adenoma.
Design: Cross-sectional study.
Setting: Two screening centres.
Participants: 42 554 men and women, aged 50-74 years, participating in a randomised CRC screening trial. 36 059 participants underwent a sigmoidoscopy (and follow-up colonoscopy if positive sigmoidoscopy) and 6495 underwent a colonoscopy after a positive faecal immunochemical test (FIT).
Primary and secondary outcome measures: Proportion of asymptomatic participants diagnosed with CRC or advanced adenomas. Prevalence of bowel symptoms (rectal bleeding, change in bowel habits, diarrhoea, constipation, bloating, alternating bowel habits, general symptoms, other bowel symptoms) recorded by the endoscopist and their association with CRC and advanced adenomas.
Results: Among sigmoidoscopy participants, 7336 (20.3%) reported at least one symptom. 120 (60%) out of 200 individuals with screen-detected CRC and 1301 (76.5%) out of 1700 with advanced adenoma were asymptomatic. Rectal bleeding was associated with detection of CRC and advanced adenoma (OR 4.3, 95% CI 3.1 to 6.1 and 1.8, 95% CI 1.5 to 2.1, respectively), while change in bowel habits only with CRC detection (OR 3.8, 95% CI 2.4 to 6.1). Among the FIT positives, 2173 (33.5%) reported at least one symptom. Out of 299 individuals with screen-detected CRC and 1639 with advanced adenoma, 167 (55.9%) and 1 175 (71.7%) were asymptomatic, respectively. Detection of CRC was associated with rectal bleeding (OR 1.8, 95% CI 1.4 to 2.3), change in bowel habits (OR 2.2, 95% CI 1.4 to 3.5) and abdominal pain (OR 1.8, 95% CI 1.2 to 2.7).
Conclusions: Some bowel symptoms increased the likelihood of being diagnosed with CRC or advanced adenoma. However, the majority of individuals with these findings were asymptomatic. Asymptomatic individuals should be encouraged to participate in CRC screening.
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Kværner, Ane Sørlie; Birkeland, Einar Elvbakken; Bucher-Johannessen, Cecilie; Vinberg, Elina; Nordby, Jan Inge & Kangas, Harri
[Show all 27 contributors for this article]
(2021).
The CRCbiome study: a large prospective cohort study examining the role of lifestyle and the gut microbiome in colorectal cancer screening participants.
BMC Cancer.
21.
doi:
10.1186/s12885-021-08640-8.
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Background: Colorectal cancer (CRC) screening reduces CRC incidence and mortality. However, current screening methods are either hampered by invasiveness or suboptimal performance, limiting their effectiveness as primary screening methods. To aid in the development of a non-invasive screening test with improved sensitivity and specificity, we have initiated a prospective biomarker study (CRCbiome), nested within a large randomized CRC screening trial in Norway. We aim to develop a microbiome-based classification algorithm to identify advanced colorectal lesions in screening participants testing positive for an immunochemical fecal occult blood test (FIT). We will also examine interactions with host factors, diet, lifestyle and prescription drugs. The prospective nature of the study also enables the analysis of changes in the gut microbiome following the removal of precancerous lesions. Methods: The CRCbiome study recruits participants enrolled in the Bowel Cancer Screening in Norway (BCSN) study, a randomized trial initiated in 2012 comparing once-only sigmoidoscopy to repeated biennial FIT, where women and men aged 50–74 years at study entry are invited to participate. Since 2017, participants randomized to FIT screening with a positive test result have been invited to join the CRCbiome study. Self-reported diet, lifestyle and demographic data are collected prior to colonoscopy after the positive FIT-test (baseline). Screening data, including colonoscopy findings are obtained from the BCSN database. Fecal samples for gut microbiome analyses are collected both before and 2 and 12 months after colonoscopy. Samples are analyzed using metagenome sequencing, with taxonomy profiles, and gene and pathway content as primary measures. CRCbiome data will also be linked to national registries to obtain information on prescription histories and cancer relevant outcomes occurring during the 10 year follow-up period. Discussion: The CRCbiome study will increase our understanding of how the gut microbiome, in combination with lifestyle and environmental factors, influences the early stages of colorectal carcinogenesis. This knowledge will be crucial to develop microbiome-based screening tools for CRC. By evaluating biomarker performance in a screening setting, using samples from the target population, the generalizability of the findings to future screening cohorts is likely to be high.
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Randel, Kristin Ranheim; Schult, Anna Lisa; Botteri, Edoardo; Hoff, Geir; Bretthauer, Michael & Ursin, Giske
[Show all 20 contributors for this article]
(2020).
Colorectal cancer screening with repeated fecal immunochemical test versus sigmoidoscopy: baseline results from a randomized trial.
Gastroenterology.
ISSN 0016-5085.
160(4),
p. 1085–1096.
doi:
10.1053/j.gastro.2020.11.037.
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Background and aims: The comparative effectiveness of sigmoidoscopy and fecal immunochemical testing (FIT) for colorectal cancer (CRC) screening is unknown.
Methods: Individuals aged 50-74 years living in South-East Norway were randomly invited between 2012 and 2019 to either once-only flexible sigmoidoscopy or FIT screening every second year. Colonoscopy was recommended after sigmoidoscopy if any polyp ≥10 mm, ≥ three adenomas, any advanced adenomas, or CRC was found or subsequent to FIT > 15 μg hemoglobin/g feces. Data for this report were obtained after complete recruitment in both groups and included two full FIT rounds and part of the third round. Outcome measures were participation, neoplasia detection, and adverse events. Age-standardized detection rates and age-adjusted odds ratios (OR) were calculated.
Results: We included 139,291 individuals; 69,195 randomized to sigmoidoscopy and 70,096 to FIT. Participation rate was 52% for sigmoidoscopy, 58% in the first FIT round and 68% for three cumulative FIT rounds. Compared to sigmoidoscopy, detection rate for CRC was similar in the first FIT round (0.25% vs 0.27%, OR 0.92, 95% CI 0.75-1.13), but higher after three FIT rounds (0.49% vs 0.27%, OR 1.87, 95% CI 1.54-2.27). Advanced adenoma detection rate was lower in the first FIT round compared to sigmoidoscopy, 1.4% vs 2.4% (OR 0.57, 95% CI 0.53-0.62), but higher after three cumulative FIT rounds, 2.7% vs 2.4% (OR 1.14, 95% CI 1.05-1.23). There were 33 (0.05%) serious adverse events in the sigmoidoscopy group compared to 47 (0.07%) in the FIT group (p =.13).
Conclusion: Participation was higher and more CRC and advanced adenomas were detected with repeated FIT compared to sigmoidoscopy. The risk of perforation and bleeding was comparable. Clinicaltrials.gov (NCT01538550).
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Knudsen, Markus Dines; Botteri, Edoardo; Holme, Øyvind; Hjartåker, Anette; Song, Mingyang & Thiis-Evensen, Espen
[Show all 11 contributors for this article]
(2020).
Association between lifestyle and site-specific advanced colorectal lesions in screening with faecal immunochemical test and sigmoidoscopy.
Digestive and Liver Disease.
ISSN 1590-8658.
p. 1–7.
doi:
10.1016/j.dld.2020.11.021.
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Background: Lifestyle factors may help to identify individuals at high-risk for colorectal cancer (CRC).
Aims: To examine the association between lifestyle, referral for follow-up colonoscopy and proximal neoplasia detection in CRC screening.
Methods: In this observational study, 14,832 individuals aged 50-74 years were invited to faecal immunochemical test (FIT) or sigmoidoscopy screening. Advanced lesions (AL), including advanced adenomas, advanced serrated lesions and CRC were divided according to location: distal-only, or proximal with or without distal AL. We collected information on smoking habit, body mass index and alcohol intake through a questionnaire.
Results: Out of 3,318 FIT and 2,988 sigmoidoscopy participants, 516 (16%) and 338 (11%), respectively, were referred for follow-up colonoscopy after a positive screening test. Two-hundred-and-fifty-six (4%) had distal-only and 119 (2%) proximal AL. In FIT participants, obesity and high alcohol intake were associated with proximal AL; odds ratio (95% confidence interval) 2.68 (1.36-5.26) and 2.16 (1.08-4.30), respectively. In sigmoidoscopy participants, current smoking was associated with proximal AL; 4.58 (2.24-9.38), and current smoking and obesity were associated with referral for colonoscopy; 2.80 (2.02-3.89) and 1.42 (1.01-2.00), respectively.
Conclusion: Current smoking, obesity and high alcohol intake were associated with screen-detected proximal colorectal AL. Current smoking and obesity were associated with referral for follow-up colonoscopy in sigmoidoscopy screening.
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Hoff, Geir; Ursin, Giske; Løberg, Magnus; Lange, Thomas de; Skovlund, Eva & Holme, Øyvind
(2019).
Continuous development of colorectal cancer screening programs.
Acta Oncologica.
ISSN 0284-186X.
3(1),
p. 822–823.
doi:
10.1080/0284186X.2019.1588475.
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Colorectal cancer (CRC) screening programs are far from perfect. Many crucial questions remain, yet expensive CRC screening services are implemented throughout the world without a plan on how to evaluate and improve the service. The time is ripe for improving the design of CRC screening programs.
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Hoff, Geir; Lange, Thomas de; Bretthauer, Michael; Dahler, Stein; Halvorsen, Fred-Arne & Huppertz-Hauss, Gert
[Show all 12 contributors for this article]
(2019).
Registration bias in a clinical quality register.
Endoscopy International Open.
7(1),
p. E90–E98.
doi:
10.1055/a-0806-7006.
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Background and aims:The quality of medical quality registers is poorly defined and lack of trust in data due to low completeness may be a major barrier against their use in quality improvement interventions. The aim of the current observational study was to explore how selective reporting may influence adverse events registered in the Norwegian quality register for colonoscopy (Gastronet). Materials and Methods:Gastronet's database includes data provided by endoscopists, nurses and patients. All outpatient colonoscopies reported to Gastronet in 2015 were included and compared to the total number of colonoscopies performed in Norway as retrieved from the National Patient Registry. Hospitals were categorized into four groups according to reporting completeness < 50 %, 50 % to 69 %, 70 % to 89 % and ≥ 90 %. The number of recorded adverse events (AEs) and procedure time were analyzed. Multivariate logistic regression models were fitted to explore independent factors for selection bias. Results: A total of 22,364 colonoscopies were reported to the National Patient Register of which 15,855 (71 %) were registered in Gastronet. Feedback was received from 11,079 patients (50 %). The frequency of AEs increased from 0.6 % in completeness group < 50 % to 1.6 % in completeness group ≥ 90 % ( P < 0.001). Long colonoscopy procedure time was associated with low reporting completeness. Patient feedback was associated with older age, cecal intubation success and sedation-free colonoscopy. Conclusion:Incomplete registration in a colonoscopy quality register is associated with underreporting of AEs. Longer procedure time, a surrogate marker for time constraint, is associated with low completeness.
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Holme, Øyvind; Pedersen, Ina Borgenheim; Medhus, Asle Wilhelm; Aabakken, Lars; Glomsaker, Tom Birger & Kvamme, Jan-Magnus
[Show all 14 contributors for this article]
(2018).
Endoscopy assistants influence the quality of colonoscopy.
Endoscopy.
ISSN 0013-726X.
50(9),
p. 871–877.
doi:
10.1055/s-0044-101706.
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Background: Colonoscopy performance varies between endoscopists, but little is known about the impact of endoscopy assistants on key performance indicators. We used a large prospective colonoscopy quality database to perform an exploratory study to evaluate differences in selected quality indicators between endoscopy assistants. Methods: All colonoscopies reported to the Norwegian colonoscopy quality assurance register Gastronet can be used to trace individual endoscopy assistants. We analyzed key quality indicators (cecum intubation rate, polyp detection rate, colonoscopies rated as severely painful, colonoscopies with sedation or analgesia, and satisfaction with information) for colonoscopies performed between 1 January 2013 and 31 December 2014. Differences between individual assistants were analyzed by fitting multivariable logistic regression models, with the best performing assistant at each participating hospital as reference. All models were adjusted for the endoscopist. Results: 63 endoscopy assistants from 12 hospitals assisted in 15 365 colonoscopies. Compared with their top performing peers from the same hospital, one assistant was associated with cecum intubation failure, four with poor polyp detection, nine with painful colonoscopy, 16 with administration of sedation or analgesics during colonoscopy, and three with patient dissatisfaction about information given relating to the colonoscopy. The number of procedures during the study period or lifetime experience as an endoscopy assistant were not associated with any quality indicator. Conclusion: In this exploratory study, there was little variation on important colonoscopy quality indicators between endoscopy assistants. However, there were differences among assistants that may be clinically important. Endoscopy assistants should be subject to quality surveillance similarly to endoscopists. © 2018 Georg Thieme Verlag KG Stuttgart
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Holme, Øyvind; Løberg, Magnus; Kalager, Mette; Bretthauer, Michael; Hernán, Miguel A. & Aas, Eline
[Show all 14 contributors for this article]
(2018).
Long-term effectiveness of sigmoidoscopy screening on colorectal cancer incidence and mortality in women and men: A randomized trial.
Annals of Internal Medicine.
ISSN 0003-4819.
168(11),
p. 775–782.
doi:
10.7326/M17-1441.
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Background: The long-term effects of sigmoidoscopy screening on colorectal cancer (CRC) incidence and mortality in women and men are unclear. Objective: To determine the effectiveness of flexible sigmoidoscopy screening after 15 years of follow-up in women and men. Design: Randomized controlled trial. (ClinicalTrials.gov: NCT00119912) Setting: Oslo and Telemark County, Norway. Participants: Adults aged 50 to 64 years at baseline without prior CRC. Intervention: Screening (between 1999 and 2001) with flexible sigmoidoscopy with and without additional fecal blood testing versus no screening. Participants with positive screening results were offered colonoscopy. Measurements: Age-adjusted CRC incidence and mortality stratified by sex. Results: Of 98 678 persons, 20 552 were randomly assigned to screening and 78 126 to no screening. Adherence rates were 64.7% in women and 61.4% in men. Median follow-up was 14.8 years. The absolute risks for CRC in women were 1.86% in the screening group and 2.05% in the control group (risk difference, −0.19 percentage point [95% CI, −0.49 to 0.11 percentage point]; HR, 0.92 [CI, 0.79 to 1.07]). In men, the corresponding risks were 1.72% and 2.50%, respectively (risk difference, −0.78 percentage point [CI, −1.08 to −0.48 percentage points]; hazard ratio [HR], 0.66 [CI, 0.57 to 0.78]) (P for heterogeneity = 0.004). The absolute risks for death from CRC in women were 0.60% in the screening group and 0.59% in the control group (risk difference, 0.01 percentage point [CI, −0.16 to 0.18 percentage point]; HR, 1.01 [CI, 0.77 to 1.33]). The corresponding risks for death from CRC in men were 0.49% and 0.81%, respectively (risk difference, −0.33 percentage point [CI, −0.49 to −0.16 percentage point]; HR, 0.63 [CI, 0.47 to 0.83]) (P for heterogeneity = 0.014). Limitation: Follow-up through national registries. Conclusion: Offering sigmoidoscopy screening in Norway reduced CRC incidence and mortality in men but had little or no effect in women.
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Pedersen, Ina Borgenheim; Løberg, Magnus; Hoff, Geir; Kalager, Mette; Bretthauer, Michael & Holme, Øyvind
(2018).
Polypectomy techniques among gastroenterologists in Norway –
a nationwide survey.
Endoscopy International Open.
6(7).
doi:
10.1055/a-0607-0727.
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Background and study aims Incomplete polyp removal has been estimated to cause 27 % of all colorectal cancers detected soon after colonoscopy. There is limited information regarding polypectomy techniques among endoscopists. The article is a nationwide survey of polypectomy techniques among Norwegian endoscopists. Materials and methods We invited all board-certified gastroenterologists in Norway to complete a web-based questionnaire about their polypectomy technique. Inadequate polypectomy techniques were defined as using biopsy forceps for polyps larger than 3 mm in diameter, using hot biopsy forceps for polypectomy, and using the same electrocautery output irrespective of polyp size and morphology. Results Twenty-six of 30 Norwegian gastroenterology departments participated in the study. A total of 119 endoscopists received the survey, and 70 (59 %) responded. Mean duration of endoscopy practice was 11.5 years, and 95 % had performed more than 1,000 colonoscopies during their career. Twenty-eight endoscopists (40 %) used one or more inadequate polypectomy techniques: 10 (14.3 %) used biopsy forceps for removal of polyps larger than 3 mm in diameter, five (7.1 %) used hot biopsy for polypectomy, and 17 (24 %) used the same electrocautery output for all polypectomies. Five (7 %) endoscopists reported that they did not remove polyps smaller than 4 mm. Conclusion A substantial number of Norwegian endoscopists use inadequate polypectomy techniques. Improved training and certification of endoscopists is warranted.
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Holme, Øyvind; Schoen, Robert E.; Senore, Carlo; Segnan, Nereo; Hoff, Geir & Løberg, Magnus
[Show all 9 contributors for this article]
(2017).
Effectiveness of flexible sigmoidoscopy screening in men and women and different age groups: Pooled analysis of randomised trials.
The BMJ.
356.
doi:
10.1136/bmj.i6673.
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Objective: To compare the effectiveness of flexible sigmoidoscopy in screening for colorectal cancer by patient sex and age. Design: Pooled analysis of randomised trials (the US Prostate, Lung, Colorectal and Ovarian cancer screening trial (PLCO), the Italian Screening for Colon and Rectum trial (SCORE), and the Norwegian Colorectal Cancer Prevention trial (NORCCAP)). Data sources: Aggregated data were pooled from each randomised trial on incidence of colorectal cancer and mortality stratified by sex, age at screening, and colon subsite (distal v proximal). Eligibility criteria for selecting studies: Invited individuals aged 55-74 (PLCO), 55-64 (SCORE), and 50-64 (NORCCAP). Individuals were randomised to receive flexible sigmoidoscopy screening once only (SCORE and NORCCAP) or twice (PLCO), or receive usual care (no intervention). Results: 287 928 individuals were included in the pooled analysis; 115 139 randomised to screening and 172 789 to usual care. Compliance rates were 58%, 63%, and 87% in SCORE, NORCCAP, and PLCO, respectively. Median follow-up was 10.5 to 12.1 years. Screening reduced the incidence of colorectal cancer in men (relative risk 0.76; 95% confidence interval 0.70 to 0.83) and women (0.83; 0.75 to 0.92). No difference in the effect of screening was seen between men younger than 60 and those older than 60. Screening reduced the incidence of colorectal cancer in women younger than 60 (relative risk 0.71; 95% confidence interval 0.59 to 0.84), but not significantly in those aged 60 or older (0.90; 0.80 to 1.02). Colorectal cancer mortality was significantly reduced in both younger and older men, and in women younger than 60. Screening reduced colorectal cancer incidence to a similar extent in the distal colon in men and women, but there was no effect of screening in the proximal colon in older women with a significant interaction between sex and age group (P=0.04). Conclusion: Flexible sigmoidoscopy is an effective tool for colorectal cancer screening in men and younger women. The benefit is smaller and not statistically significant for women aged over 60; alternative screening methods that more effectively detect proximal tumours should be considered for these women.
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Hoff, Geir; Holme, Øyvind; Bretthauer, Michael; Sandvei, Per; Darre-Næss, Ole & Stallemo, Asbjørn
[Show all 11 contributors for this article]
(2017).
Cecum intubation rate as quality indicator in clinical versus screening colonoscopy.
Endoscopy International Open.
5(6),
p. E489–E495.
doi:
10.1055/s-0043-106180.
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Background and study aims: Some guidelines recommend a minimum standard of 90 % cecal intubation rate (CIR) in routine clinics and 95 % in screening colonoscopy, while others have not made this distinction – both with limited evidence to support either view. This study questions the rationale for making such differentiation. Patients and methods: We assessed cecum intubation rates amongst colonoscopies recorded in the Norwegian national quality register Gastronet by 35 endoscopists performing both clinical and screening colonoscopies. Colonoscopies were categorized into primary screening colonoscopy, work-up colonoscopy of screen-positives and clinical colonoscopy or surveillance. Cases with insufficient bowel preparation or mechanical obstruction were excluded. Endoscopists were categorized into “junior” and “senior” endoscopists depending on training and experience. Univariable and multivariable logistic regression analyses were applied. Results: During a 2-year period, 10,267 colonoscopies were included (primary screening colonoscopy: 746; work-up colonoscopy of screen-positives: 2,604; clinical colonoscopy or surveillance: 6917). The crude CIR in clinical routine colonoscopy, primary screening colonoscopy and work-up colonoscopy was 97.1 %, 97.1 % and 98.6 %, respectively. In a multiple logistic regression analysis, there were no differences in CIR between the 3 groups. Poor bowel cleansing and female sex were independent predictors for intubation failure. Conclusion: Cecal intubation rate in clinical colonoscopies and colonoscopy screening are similar. There is no reason to differentiate between screening and clinical colonoscopy with regard to CIR.
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Moritz, Volker; Holme, Øyvind; LeBlanc, Marissa & Hoff, Geir
(2016).
An explorative study from the Norwegian Quality Register Gastronet comparing self-estimated versus registered quality in colonoscopy performance.
Endoscopy International Open.
4(3),
p. E326–332.
doi:
10.1055/s-0042-100904.
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Swanson, Sonja; Holme, Øyvind; Løberg, Magnus; Kalager, Mette; Bretthauer, Michael & Hoff, Geir
[Show all 8 contributors for this article]
(2015).
Bounding the per-protocol effect in
randomized trials: an application to
colorectal cancer screening.
Trials.
16(541).
doi:
10.1186/s13063-015-1056-8.
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Background The per-protocol effect is the effect that would have been observed in a randomized trial had everybody followed the protocol. Though obtaining a valid point estimate for the per-protocol effect requires assumptions that are unverifiable and often implausible, lower and upper bounds for the per-protocol effect may be estimated under more plausible assumptions. Strategies for obtaining bounds, known as “partial identification” methods, are especially promising in randomized trials. Results We estimated bounds for the per-protocol effect of colorectal cancer screening in the Norwegian Colorectal Cancer Prevention trial, a randomized trial of one-time sigmoidoscopy screening in 98,792 men and women aged 50–64 years. The screening was not available to the control arm, while approximately two thirds of individuals in the treatment arm attended the screening. Study outcomes included colorectal cancer incidence and mortality over 10 years of follow-up. Without any assumptions, the data alone provide little information about the size of the effect. Under the assumption that randomization had no effect on the outcome except through screening, a point estimate for the risk under no screening and bounds for the risk under screening are achievable. Thus, the 10-year risk difference for colorectal cancer was estimated to be at least −0.6 % but less than 37.0 %. Bounds for the risk difference for colorectal cancer mortality (–0.2 to 37.4 %) and all-cause mortality (–5.1 to 32.6 %) had similar widths. These bounds appear helpful in quantifying the maximum possible effectiveness, but cannot rule out harm. By making further assumptions about the effect in the subpopulation who would not attend screening regardless of their randomization arm, narrower bounds can be achieved. Conclusions Bounding the per-protocol effect under several sets of assumptions illuminates our reliance on unverifiable assumptions, highlights the range of effect sizes we are most confident in, and can sometimes demonstrate whether to expect certain subpopulations to receive more benefit or harm than others. Trial registration Clinicaltrials.gov identifier NCT00119912 (registered 6 July 2005)
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Holme, Øyvind
(2014).
Invitation for flexible sigmoidoscopy screening reduced colorectal cancer and colorectal cancer mortality.
Annals of Internal Medicine.
ISSN 0003-4819.
161(12),
p. JC2–JC2.
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Løberg, Magnus; Kalager, Mette; Holme, Øyvind; Hoff, Geir; Adami, Hans Olov & Bretthauer, Michael
(2014).
Long-Term Colorectal-Cancer Mortality after Adenoma Removal.
New England Journal of Medicine.
ISSN 0028-4793.
371(9),
p. 799–807.
doi:
10.1056/NEJMoa1315870.
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Holme, Øyvind; Bretthauer, Michael; Løberg, Magnus; Kalager, Mette & Adami, Hans Olov
(2019).
Revisiting surveillance schemes for cancer survivors.
Annals of Oncology.
ISSN 0923-7534.
30(6),
p. 881–883.
doi:
10.1093/annonc/mdz107.
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Holme, Øyvind; Bretthauer, Michael; Løberg, Magnus; Kalager, Mette & Adami, Hans-Olov
(2019).
Reply to the letter to the editor 'Cancer survivors: Surveillance or not surveillance?' by Santeufemia and Miolo.
Annals of Oncology.
ISSN 0923-7534.
30(9),
p. 1532–1532.
doi:
10.1093/annonc/mdz190.
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Holme, Øyvind; Løberg, Magnus Bjørson; Kalager, Mette; Bretthauer, Michael & Hoff, Geir
(2018).
In response.
Annals of Internal Medicine.
ISSN 0003-4819.
169(9),
p. 663–664.
doi:
10.7326/L18-0512.
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Holme, Øyvind & Aabakken, Lars
(2018).
Making colonoscopy smarter with standardized computer-aided diagnosis.
Annals of Internal Medicine.
ISSN 0003-4819.
169(6),
p. 409–410.
doi:
10.7326/M18-1901.
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Zahl, P-H; Holme, Øyvind & Løberg, Magnus
(2016).
Norsk mammografiscreening - mange selvmotsigelser i evalueringen :.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
136(19),
p. 1616–1618.
doi:
10.4045/tidsskr.16.0165.
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Awan, Laiba Maryum; Engdal, Selma Løchen; Matheswaran, Sellan; Næsset, Tor Magnus; Sjaavik, Anja Sofie Dusik & Esposito, Sarah
[Show all 7 contributors for this article]
(2026).
Når taushetsplikten utfordres.
Universitetet i Oslo.
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Å opprettholde taushetsplikten under legevisitten på flersengsrom oppleves som en utfordring under den daglige driften ved flere sykehusavdelinger. Lovverket er imidlertid tydelig: som helsepersonell er vi pliktige til å forhindre at uvedkommende får tilgang til sensitiv pasientinformasjon. Av erfaring opplever vi store variasjoner i hvordan taushetsplikten etterleves den daglige visitten ved ulike avdelinger. De største utfordringene som trekkes frem er tid- og effektivitetspress og mangel på fysiske strukturer. Da vi også har erfaringer fra avdelinger hvor taushetsplikten ivaretas under visitt, også i en travel og ressursbegrenset hverdag, vurderte vi dette som et godt utgangspunkt for et kvalitetsforbedringsprosjekt. I denne oppgaven har vi samarbeidet med Hjertemedisinsk avdeling på Ullevål Sykehus, OUS. Kartlegging av dagens praksis viste en avdeling uten formelle retningslinjer på hvordan legevisitten på flersengsrom skulle utføres. Sentrale utfordringer var begrenset tilgang på - og dårlig utformede samtalerom, samt tid- og ressursbruk. Med forankring i lovverket, et strukturert litteratursøk og erfaring fra andre sengepostavdelinger, foreslår vi å innføre bruk av hørselsvern som tiltak for å bedre ivareta taushetsplikten under visitt på flersengsrom. Vi anser at det vil være et verktøy som hindrer at medpasienter får tilgang til sensitiv informasjon som utveksles mellom pasient og lege. Målet er at innen 1. februar 2027 skal alle legevisitter på flersengsrom hvor det er medpasienter til stede, utføres med bruk av høreklokker for å sikre at taushetsplikten overholdes. Ved hjelp av sjekklister vurderes antall legevisitter som gjennomføres med bruk av hørselsvern. Implementeringen av tiltaket forutsetter forankring i ledelsen, tett involvering av ansatte og tilrettelegging av nødvendige strukturelle forhold, som innkjøp og rutiner for bruk av utstyr. Pilotutprøving i ett tun anbefales for å teste gjennomførbarhet og justere tiltaket før eventuell oppskalering. Oppgaven viser at selv om strukturelle forhold kan begrense optimal ivaretakelse av taushetsplikt, finnes det gjennomførbare tiltak som kan redusere utfordringene betydelig. Dette kvalitetsforbedringsarbeidet bidrar med å styrke konfidensialitet mellom lege og pasient, som videre kan føre til mer presis informasjonsutveksling, bedre den medisinske behandlingen og øke pasientens tillit til helsetjenesten.
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Published
Mar. 11, 2015 3:46 PM
- Last modified
May 31, 2016 3:36 PM
