The NordICC Study: rationale and design of a randomized trial on colonoscopy screening for colorectal cancer.
OBJECTIVE
While colonoscopy screening is widely used in several European countries and the United States, there are no randomized trials to quantify its benefits. The Nordic-European Initiative on Colorectal Cancer (NordICC) is a multinational, randomized controlled trial aiming at investigating the effect of colonoscopy screening on colorectal cancer (CRC) incidence and mortality. This paper describes the rationale and design of the NordICC trial.


METHODS
Men and women aged 55 to 64 years are drawn from the population registries in the participating countries and randomly assigned to either once-only colonoscopy screening with removal of all detected lesions, or no screening (standard of care in the trial regions). All individuals are followed for 15 years after inclusion using dedicated national registries. The primary end points of the trial are cumulative CRC-specific death and CRC incidence during 15 years of follow-up. POWER ANALYSIS: We hypothesize a 50 % CRC mortality-reducing efficacy of the colonoscopy intervention and predict 50 % compliance, yielding a 25 % mortality reduction among those invited to screening. For 90 % power and a two-sided alpha level of 0.05, using a 2:1 randomization, 45 600 individuals will be randomized to control, and 22 800 individuals to the colonoscopy group. Interim analyses of the effect of colonoscopy on CRC incidence and mortality will be performed at 10-year follow-up.


CONCLUSIONS
The aim of the NordICC trial is to quantify the effectiveness of population-based colonoscopy screening. This will allow development of evidence-based guidelines for CRC screening in the general population.
Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
M F
MF
Kaminski
M
M
Bretthauer
A G
AG
Zauber
E J
EJ
Kuipers
H-O
HO
Adami
M
M
van Ballegooijen
J
J
Regula
M
M
van Leerdam
T
T
Stefansson
L
L
Påhlman
E
E
Dekker
M A
MA
Hernán
K
K
Garborg
G
G
Hoff
D003113:Colonoscopy / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D010349:Patient Compliance; D018579:Patient Selection; D012042:Registries; D012107:Research Design; D016019:Survival Analysis; D016896:Treatment Outcome