Colorectal Cancer Screening

Bowel Cancer Screening in Norway – a pilot study

During 2012, 140 000 men and women aged 50-74 years old from the counties of Østfold, Akershus and Buskerud were invited to participate in a pilot project: A pilot project on screening for colorectal cancer, i.e. cancer in the colon and rectum.

Every day, ten Norwegians are diagnosed with colon or rectal cancer. Norway has one of the world’s highest incidence of colon cancer. This is a cancer that often does not give symptoms at an early stage.

Why is this project important?

• Colorectal cancer is among our most frequent cancer types among men and women with 4500 new cases per year, and has a 5 year survival around 70 per cent.
• Symptoms from colon cancer often appear at a late stage, when the prognosis, over time, is uncertain or poor.
• Alternatives to surgery (radiation/chemotherapy) have limited effect.
• Norway has one of the world’s highest incidence of colorectal cancer. Most countries in Europe have introduced or are planning to start screening, according to EU recommendations.
• The best screening test for use in public health is still not decided. We therefore wish to compare two screening modalities against each other. Both an immunochemical test for hidden (occult) blood (iFOBT) and flexible sigmoidoscopy test discover about 7-8 out of ten cases of colorectal cancer. Another, flexible sigmoidoscopy test discovers ca seven out of ten. False positive tests are a problem with iFOBT (only 5 out of 100 with a positive test will be diagnosed with colorectal cancer). However, this is a non-invasive method compared to flexible sigmodoscopy, and it is done at home.
• The pilot project and recently started national screening programme, aim to keep a critical eye on screening. This includes trying out alternative screening methods and strategies, in order to contiuously optimise this new health service.

Extended positive effects of the pilot project

• Six new gastroenterology trained posts have been established (LIS-posts) in order to strengthen specialist competence on gastrointestinal diseases, in general and colonoscopy specifically.
• To further strengthen endoscopy competence an “endoscopy school” at Oslo University Hospital has been established. There is insufficient capacity for colonoscopy in Norway. Therefore, the Norwegian Directorate of Health has urged the regional health trusts to take action to reduce waiting time for colonoscopy and assess the posibility of establishing “endoscopy schools”.

• The pilot project is designed as a randomized study and will function as a platform for Comparative Effectiveness Research (CER). The goal being continuous improvement of better screening services. This kind of organization has previously led to a number of studies resulting in valuable information that can be used in  clinical work and improvement of health service for patients (ie. people who are sick - not healthy participants in screening). This is nicely demonstrated in the earlier screening project NORCCAP.
  
  
  NORCCAP also led to the establishment of the present countrywide quality assurrance programme Gastronet , which aims to develop quality and access to gastrointestinal examinations for patients.