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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: After adjusting for contamination bias, an invitation to fecal occult blood test screening was linked to a 26% reduction in CRC mortality. Screening participation was associated with a 43% reduction. An invitation to participate in a fecal occult blood test screening program in Sweden was associated with a 26% decline in colorectal cancer mortality, which jumped to a 43% decline for participating, results of a prospective study showed. \u201cOne of the major challenges in colorectal cancer screening is demonstrating the effectiveness of an ongoing population-based screening program,\u201d Johannes Blom, MD, PhD, a principal researcher who specializes in cancer prevention and screening at Karolinska Institutet, told Healio. \u201cRandomized trials conducted several decades ago showed that fecal occult blood test screening can reduce colorectal cancer mortality, but evaluating contemporary screening programs is much more difficult because suitable control groups are often lacking.\u201d
Data derived from\u00a0Blom J, et al. JAMA Netw Open. 2026;doi:10.1001\/jamanetworkopen.2026.29856.
Link between CRC screening, mortality In 2024, Blom and colleagues published an analysis of a Swedish program that invited residents of the country\u2019s Stockholm-Gotland region to fecal occult blood test (FOBT) screening. They observed a 14% decline in CRC mortality among invitees. Johannes Blom \u201cHowever, we suspected that this [analysis] underestimated the true effectiveness of screening, because many individuals in the control group were eventually invited to screening,\u201d Blom said. Additionally, the initial analysis included deaths caused by CRC diagnosed years after screening invitations stopped, according to Blom. \u201cWe therefore wanted to develop a method that could address these challenges and provide a more accurate estimate of the association between screening and colorectal cancer mortality,\u201d he said. In a prospective cohort study, the researchers adjusted for CRC deaths associated with diagnosis occurring more than 2 years after screening invitations stopped. They also excluded individuals in the control group who had received an invitation to screening. \u201c[This] method also made it possible to evaluate the association between actual participation in screening and colorectal cancer mortality,\u201d Blom said. The researchers included an additional 40 deaths from a national Swedish database in the 2026 study, but otherwise used the same data as the 2024 publication. More than 375,000 individuals aged 60 to 69 years were randomly assigned by birth year to a study group (n = 203,692; 48.8% men; mean age at start of follow-up, 63.6 years), which received an invitation to FOBT screening from 2008 to 2012, or a control group (n = 172,819; 49% men; mean age at start of follow-up, 62.8 years), which received no screening invitation or an invitation between 2013 and 2015. \u2018Substantial impact\u2019 of participation Overall, 1,668 CRC-related deaths occurred during 14 years of follow-up: 856 in the study group and 812 in the control group. After adjustment for deaths related to CRC diagnosed more than 2 years after invitations ceased in the study group, CRC mortality declined 19% (RR = 0.81; 95% CI, 0.69-0.94). When researchers also excluded deaths among screening invitees in the control group, they observed a 26% decrease in mortality (RR = 0.74; 95% CI, 0.58-0.94). \u201cThese findings suggest that the benefits of organized colorectal cancer screening may be substantially underestimated when contamination is not adequately addressed,\u201d Blom said. Blom called attention to the marked effect of FOBT participation on mortality. When nonadherence in the study group and screening participation in the control group were accounted for, mortality fell 43% (RR = 0.57; 95% CI, 0.4-0.8). \u201cEven the best screening program can only prevent deaths among people who actually take part,\u201d he said. \u201cEfforts to improve adherence to screening invitations, simplify testing procedures and reduce barriers to participation are therefore likely to have a substantial impact.\u201d Study limitations include residual confounding stemming from merging data on covariates \u2014 age and follow-up time \u2014 into broader intervals. \u201cWe believe there is a need for additional research on methods to evaluate ongoing screening programs, because many countries face similar challenges regarding contamination, nonadherence and the lack of truly unexposed control groups,\u201d Blom told Healio. For more information: Johannes Blom, MD, PhD, associate professor in the department of clinical science and education at Karolinska Institutet, can be reached at johannes.blom@ki.se. Perspective Back to Top This study proposes an updated methodological framework to estimate the association of invitation to and participation in fecal occult blood screening \u2014 guaiac FOBT and fecal immunochemical test \u2014 with reductions in CRC mortality, building on Blom and colleagues\u2019 2024 study. In particular, the authors introduced a time limit for defining screening exposure, adjusting for study group deaths when CRC was diagnosed more than 2 years after the person\u2019s last screening invitation, in line with the biennial invitation interval. After adjustment for these nonexposed cases in the study group, the estimated risk ratio corresponded to a 19% reduction in incidence-based CRC mortality. The authors also adjusted for contamination in the control group (individuals who were eventually invited to screen and thus not truly unexposed). By assessing actual exposure rather than the original group assignment, the estimated effect of invitation to screening was a 26% reduction in CRC mortality. The authors further adjusted for nonparticipants (those who were invited in the last screening round preceding a CRC diagnosis, but did not participate), yielding a larger estimated reduction to 30% when adjusted for participation in the study group, a 38% reduction when adjusted for participation in the control group and a 43% reduction with crude adjustment of the residual unexposed deaths. These findings underscore the importance of screening uptake and participation in stool-based CRC screening in real-world practice. Impressively, there is more than a 25% reduction<\/p>\n","protected":false},"author":1,"featured_media":4266,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4265","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/4265","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4265"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/4265\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/4266"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4265"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4265"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4265"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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