Colonoscopy is still the most recommended screening for colorectal cancer, despite conflicting headlines and flawed interpretations of a new study

A recently published study in a high-profile medical journal appeared to call into question the efficacy of colonoscopy, a proven and widely utilized strategy for the screening and prevention of colorectal cancer.

News headlines were striking: “Disappointing results on colonoscopy benefits”; “New study suggests benefits of colonoscopies may be overestimated”; “In gold-standard trial, invitation to colonoscopy reduced cancer incidence but not death.”

Such news coverage has ignited controversy and created some confusion about the study and its implications, leading people to question whether the results suggest that reevaluation of the utility and need for a colonoscopy is warranted.

As a cancer research scientist with over 20 years of experience studying colorectal cancer screening and prevention, I am confident that colonoscopy remains one of the most critical and effective tools to screen for, detect and prevent this prevalent and lethal form of cancer.

Colorectal cancer is the fourth-most prevalent and second-leading cause of cancer deaths in the U.S. The American Cancer Society estimates that there will be 151,000 new cases of colorectal cancer diagnosed in 2022 and nearly 53,000 deaths. Screening has contributed markedly to a decline in colorectal cancer cases and deaths over the past several decades.

Current U.S. Preventive Services Taskforce guidelines recommend that people with average risk begin screening for colorectal cancer at the age of 45. This recommendation was lowered from age 50 in 2021 due to the recent increase in colorectal cancer disease prevalence among young adults.

Several investigations have shown that colonoscopy screening is highly effective in the detection and removal of precancerous polyps before they progress to cancer.

That is why media coverage of the new study published in the New England Journal of Medicine prompted confusion and concern among health care experts and the public. Many of these news reports mistakenly interpreted the study as showing that colonoscopies have a small effect on the incidence of colorectal cancer and are ineffective at reducing deaths. Such misinterpretations could have grave consequences with regard to efforts aimed at screening and preventing a form of cancer that affects the health and well-being of so many.

In the study, a team of European researchers performed a randomized clinical trial that examined the risk of colorectal cancer and death in healthy men and women between the ages of 55 and 64. Study participants, who were recruited from population registries in Norway, Sweden, Poland and the Netherlands, were either invited to undergo a colonoscopy or were not invited and received usual care.

After approximately 10 years, the research team gathered information on colorectal cancer incidence and deaths among 28,220 in the invited group and 56,365 in the uninvited group. They found that those in the invited group had a mere 18% decrease in the number of cases of colorectal cancer relative to those in the uninvited group. They also found that there was no significant reduction in deaths in the invited group. This seemingly disappointing result drove many of the more misleading headlines in the media.

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