The Risk of Colorectal Cancer Incidence and Mortality after Screening and Adenoma Removal
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Abstract
Colorectal cancer is a major health burden worldwide. Screening for colorectal cancers and surveillance programmes after adenoma removal have been implemented in many countries to decrease the risk of colorectal cancer incidence and mortality. This thesis aims to investigate the effect of colorectal cancer screening and adenoma removal on colorectal cancer incidence and mortality, as well as the risk of colorectal cancer death from an interval cancer occurring between two screening episodes. The thesis includes a systematic review and meta-analysis of existing randomised controlled trials on colorectal cancer screening, a subanalysis of a randomised controlled trial on colorectal cancer screening (the NORCCAP study), as well as a cohort study of 40,000 Norwegian individuals 40 years or older who have had an adenoma removed. Colorectal cancer screening with guaiac faecal occult blood test and sigmoidoscopy had a long-lasting effect on colorectal cancer mortality of at least 15 years. Individuals who experienced an interval cancer after a negative screening exam had similar prognosis to clinically detected cancers. Both sigmoidoscopy screening and adenoma removal had less effect in women than in men, thus sex-specific guidelines should be considered.List of papers
Paper I: Colorectal cancer screening with faecal testing, sigmoidoscopy or colonoscopy: a systematic review and network meta-analysis. Henriette C. Jodal, Lise M. Helsingen, Joseph C. Anderson, Lyubov Lytvyn, Per Olav Vandvik, Louise Emilsson. BMJ Open 2019;9:e032773. doi:10.1136/bmjopen-2019-032773. The article is included in the thesis. Also available at: https://doi.org/10.1136/bmjopen-2019-032773 |
Paper II: Mortality From Postscreening (Interval) Colorectal Cancers Is Comparable to That From Cancer in Unscreened Patients - A Randomized Sigmoidoscopy Trial. Henriette C. Jodal, Magnus Løberg, Øyvind Holme, Hans-Olov Adami, Michael Bretthauer, Louise Emilsson, David F. Ransohoff, Geir Hoff, Mette Kalager. Gastroenterology 2018;155:1787–1794. doi:10.1053/j.gastro.2018.08.035. The article is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1053/j.gastro.2018.08.035 |
Paper III: Long-Term Colorectal Cancer Incidence and Mortality for Women and Men. Henriette C. Jodal, Dagmar Klotz, Magnhild Herfindal, Ishita Barua, Petter Tag, Lise M. Helsingen, Erle Refsum, Øyvind Holme, Hans-Olov Adami, Michael Bretthauer, Mette Kalager, Magnus Løberg. Aliment Pharmacol Ther. 2022; 55: 412– 421. doi:10.1111/apt.16686. The paper (manuscript) is included in the thesis. Also available at: https://doi.org/10.1111/apt.16686 |