Pilot Study of a National Screening Programme for Bowel Cancer in Norway

Colorectal Cancer Clinical Trial

Official title:

Colorectal Cancer Screening in Norway: Pilot Study of a National Screening Programme With Randomised Comparison of Different Screening Strategies to Provide the Best Possible Service to the Population

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT01538550
• Other study ID #: CRCpilotNorway
• Status: Active, not recruiting
• Phase: N/A
• Start date: March 2012
• Est. completion date: December 2030

Study information

• Verified date: January 2021
• Source: Cancer Registry of Norway
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The Norwegian government has funded a pilot study of a national colorectal cancer screening programme. This implies initiation of a screening pilot in the catchment area for two hospitals in Norway. The target population is average risk men and women at age 50-74 years. The programme is designed as a comparative effectiveness programme evaluating acceptance and test performance for two screening methods - fecal occult blood testing (FOBT) and flexible sigmoidoscopy (FS). This protocol describes the main methodological issues, necessary resources and the expected effects.

Description:

There are several candidate screening modalities - fecal occult blood (FOBT), flexible sigmoidoscopy, colonoscopy, CT and MRI colonography and a range of molecular markers. Of these, only FOBT and FS have been subjected to long-term follow-up in randomised trials (RCTs). These two modalities will be tested in a head-to-head comparison by 1:1 randomisation. Previous studies have suggested that the attendance for FS may be lower than for FOBT. However, participation has been shown to decline with repetitive rounds required for FOBT, while infrequent or once-only screening may suffice for FS. A better test performance for FS makes it uncertain which method may be most beneficial in a public health perspective. This is the first time a national screening programme is designed as a platform for comparative effectiveness studies.

The pilot study will be carried out in two hospital catchment areas in South-East Norway - each with a target population of 70,000 men and women at 50-74 years of age - altogether 140,000 individuals to be randomised 1:1 between screening with an immunochemical test for faecal occult blood (iFOBT) biennially or FS once only. The primary endpoint is colorectal mortality reduction after 10 years. Attendance for FS is expected to be 50% and 60% for iFOBT. Expected CRC mortality reduction is 30% (286 CRC deaths) in the FS arm and 15% (143 CRC deaths) in the iFOBT arm (intention-to-treat). In a 1:1 randomisation with 80% statistical power and a significance level of 5% it will require 70,000 individuals in each arm to disclose a statistically significant difference between FS and iFOBT screening in an intention-to-treat model. We expect 5% in the iFOBTs group to test positive and require colonoscopy work-up. A positive FS is defined as 'any advanced neoplasia' (CRC, adenoma >10mm, adenoma with high-grade dysplasia or villous components). A finding of advanced neoplasia is expected in 5% of FS requiring full colonoscopy.

Study entry-date: All individuals were randomized to each of the two groups (iFOBT or sigmoidoscopy) before study start. Because first round screening of the iFOBT arm (70,000 invitees) will be finished in a shorter time frame compared to sigmoidoscopy, invitees in the flexible sigmoidoscopy arm are prone to more relevant time-dependent events between randomization and time of screening actually being offered. Therefore, primary entry-date was defined as day of mailed invitation in both screening groups. This approach means that the mean age at invitation in the sigmoidoscopy screening group will be older than in the iFOBT group, and analyses have to take this age-difference into account. Randomization date was chosen as a secondary study entry date to allow comparative analysis of effects of choosing the two entry date definitions. Sub-studies on lifestyle, psychological reactions comparing participants and control groups not invited to screening from neighbouring municipalities are performed. A randomized sub-study comparing various premedication in work-up colonoscopies is also performed.

Sub-studies

1. Changes in modifiable lifestyle factors such as not smoking, normal weight, high level of physical activity may reduce the risk of CRC. Correlation between these factors and endoscopic findings will be assessed. Limited intervention will be tested to improve life style.

2. The effect of screening on Psychological factors and the willingness to repeat screening will be assessed

3. Creation of a validated Sigmoidoscopy Bowel Preparation scale with subsequent testing of various bowel preparation modalities will be performed.

4. RCT with various strategies og analgesia during colonoscopy will be tested to improve patient experience.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 140000
• Est. completion date: December 2030
• Est. primary completion date: December 2028
• Accepts healthy volunteers: No
• Gender: All
• Age group: 50 Years to 74 Years

Eligibility

Inclusion Criteria:

• men and women

• age 50-74 years

• living in defined geographic areas in South-East Norway (catchment areas for two hospitals)

Exclusion Criteria:

• previous colorectal cancer

Related Conditions & MeSH terms

• Adenoma
• Colorectal Adenomas
• Colorectal Cancer
• Colorectal Neoplasms

Intervention

Procedure:
• Flexible sigmoidoscopy
Flexible sigmoidoscopy screening is offered once only
• iFOBT
Biennial screening with iFOBT

Locations

Country	Name	City	State
Norway	Moss Hospital	Oslo
Norway	Bærum County Hospital	Rud

Sponsors (2)

Lead Sponsor	Collaborator
Cancer Registry of Norway	University of Oslo

Country where clinical trial is conducted

Norway, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Bowel preparation in Sigmoidoscopy	Improved strategy for bowel preparation	1 year start Fall 2017
Other	Pain reduction during Colonoscopy	Test various strategies for analgesia during colonoscopy	18 months from Fall 2017
Primary	colorectal cancer mortality	colorectal cancer mortality after 10 years of follow-up, possibly extending to 15 years of follow-up	10 years
Secondary	Colorectal cancer incidence	Colorectal cancer incidence after 10 years of follow-up, possibly extending to 15 years of follow-up	10 years
Secondary	Complications and quality assurance	Both screening arms will be subject to continuous registration of complications and quality assurance measures of screening itself and work-up of screening positives	4 years
Secondary	Psychological effects of screening	The level and duration of psychological reactions to screening (anxiety, quality of life) and influence on lifestyle (smoking, physical exercise, dietary habits) will be assessed during the first 4-5 active screening years of the study	5 years

External Links

•   Web page for the study being translated into English