[Comment] Colonoscopy, cancer prevention, and the new arithmetic of benefit

Colonoscopy, cancer prevention, and the new arithmetic of benefit Affiliations & Notes Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA Article Info Publication History: Published May 4, 2026 DOI: 10.1016/S0140-6736(26)00794-4 External LinkAlso available on ScienceDirect External Link Copyright: © 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies. Download started OkFor more than two decades, colonoscopy has been promoted as the gold standard for colorectal cancer screening. Policy makers and professional societies have largely accepted observational data and modelling estimates that suggest that colonoscopy cuts colorectal cancer incidence and mortality by at least 50%.1 Against this backdrop of strong belief but insufficient randomised evidence, the NordICC randomised clinical trial of colonoscopy screening versus usual care for the primary endpoints of colorectal cancer incidence and mortality has been uniquely important.2 The study's 13-year results compel a recalibration of what colonoscopy can—and cannot—achieve at the population level. References 1. US Preventive Services Task Force Screening for colorectal cancer: US Preventive Services Task Force recommendation statement JAMA. 2021; 325:1965-1977 2. Bretthauer, M ∙ Løberg, M ∙ Wieszczy, P ∙ et al., the NordICC Study Group Effect of colonoscopy screening on risks of colorectal cancer and related death N Engl J Med. 2022; 387:1547-1556 3. Kaminski, MF ∙ Kalager, M ∙ Løberg, M ∙ et al. Long-term effects of colonoscopy screening on colorectal cancer incidence and mortality: a multicountry, population-based randomised controlled trial Lancet. 2026; published online May 5. https://doi.org/10.1016/S0140-6736(26)00508-8 4. Shaukat, A ∙ Mongin, SJ ∙ Geisser, MS ∙ et al. Long-term mortality after screening for colorectal cancer N Engl J Med. 2013; 369:1106-1114 5. Miller, EA ∙ Pinsky, PF ∙ Schoen, RE ∙ et al. Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: long-term follow-up of the randomised US PLCO cancer screening trial Lancet Gastroenterol Hepatol. 2019; 4:101-110 6. Atkin, W ∙ Wooldrage, K ∙ Parkin, DM ∙ et al. Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: the UK Flexible Sigmoidoscopy Screening randomised controlled trial Lancet. 2017; 389:1299-1311 7. Senore, C ∙ Riggi, E ∙ Armaroli, P ∙ et al. Long-term follow-up of the Italian Flexible Sigmoidoscopy Screening Trial Ann Intern Med. 2022; 175:36-45 8. Shaukat, A ∙ Kaalby, L ∙ Baatrup, G ∙ et al. Effects of screening compliance on long-term reductions in all-cause and colorectal cancer mortality Clin Gastroenterol Hepatol. 2021; 19:967-975.e2 9. Holme, Ø ∙ Løberg, M ∙ Kalager, M ∙ et al., the NORCCAP Study Group Long-term effectiveness of sigmoidoscopy screening on colorectal cancer incidence and mortality in women and men: a randomized trial Ann Intern Med. 2018; 168:775-782