A large Swedish randomized trial (SCREESCO), published in Nature Medicine, evaluated over 278,000 60-year-olds assigned to:
- Primary colonoscopy
- FIT (fecal immunochemical testing) with follow-up colonoscopy if positive
- Usual care (no screening)
Unlike most prior trials, SCREESCO included a true usual-care control arm, allowing direct comparison of real-world screening impact.
Key Findings
- Both colonoscopy and FIT increased early-stage colorectal cancer detection.
- FIT showed a reduction in advanced CRC incidence:
- 0.61% in FIT group vs 0.73% in control
- 0.61% in FIT group vs 0.73% in control
- Removal of precancerous adenomas likely contributed to preventive effects.
- Slight increase in bleeding and clotting events in colonoscopy groups, but complications were rare.
- All-cause mortality was similar across groups (long-term CRC mortality data pending).
Participants will be followed through 2030 to determine mortality impact.