Jason Dominitz, MD, MHS

Congratulations @gnioannou on your important paper in @AnnalsofIM on the value of booster vaccines for #COVID19. So proud of you for the great work you are doing! acpjournals.org/doi/10.7326/M2…

@dmc200802 @NEJM Cologuard has been compared to FIT and colonoscopy for one time use. No studies of incidence or mortality impact of Cologuard available at this time. Three huge studies comparing cancer mortality with non-invasive FIT vs. colonoscopy are underway in US and Europe.

The NordICC study of invitations for screening colonoscopy vs. no screening in @NEJM has generated a lot of debate about the value of #colonoscopy. I hope this Q&A with CNN sheds some additional light on the topic. Screening saves lives! #GITwitter cnn.com/2022/10/10/hea…

@GoBluePoopMD @TODAYshow Question of age to start screening is very complicated. #ColonCancer risk increases with age. Starting earlier than 55 will save more lives but will also require more resources per cancer prevented. Screening resources are very limited in many areas. Start at age 45 in the US.

@JasonDominitz @TODAYshow I wonder if you start screening sooner than 55 (as we do in the United States) if you can reduce mortality even further given a subset of colon cancers will already have metastatic spread by 60s

More discussion about the landmark NordICC screening #colonoscopy study. For those who had colonoscopy, #coloncancer mortality was reduced by 50%! While less than we hoped, it is still impressive. Don't cancel your colonoscopy! #GITwitter today.com/health/need-co… via @TODAYshow

@GoBluePoopMD @TODAYshow Early in the study, #colonoscopy finds asymptomatic cancers, looking like scope causes cancer. But removing polyps prevents cancers. Control group cancers won’t be found until symptoms develop. So scope benefits begin to show around 5-10 yrs & may continue to increase with time.

@JasonDominitz @TODAYshow I have a question that perhaps you can answer. In these types of analysis, the screening arm seems disadvantaged initially at colon cancer “prevention” since they are actually looking. This effect seems visible until the lines flip on the main figure. How is that accounted for?

@RashidLui @NEJM The risk of #coloncancer varies by country and ethnicity. Obesity, tobacco, & alcohol use are some of the known risk factors for colon cancer and polyps. These factors can impact study results. Note that Europe has higher colon cancer rates than N America per GLOBOCAN 2020.

@JasonDominitz @NEJM Thanks for sharing, and penning a thoughtful editorial! Thank you Do you think the baseline risk profile also makes a difference? I’d believe obesity is a bigger problem in North America cf with Nordic countries/Poland

@AnnalsofIM study pooled 4 huge studies of sigmoidoscopy (sig). #ColonCancer incidence reduced by 21% and deaths reduced by 20%. All-cause deaths reduced by 2%. #colonoscopy examines the whole colon (sig examines only ~1/2), so benefits should be greater! acpjournals.org/doi/10.7326/M2…

Though the NordICC study leaves many questions unanswered, it does confirm that #colonoscopy reduces #colorectalcancer incidence. For those who were invited and had a colonoscopy, it reduced colon cancer-related deaths by 50%! Screening adherence is the key to cancer prevention.

@cchildersmd @NEJM There is also reason to believe colonoscopy can do even better! It appears higher risk individuals may have been more likely to agree to colonoscopy in NordICC. With high quality colonoscopy, I do believe we can reduce mortality by >50%.

@JasonDominitz @NEJM 50%! we never see effect sizes that large... that should be the takehome

Surprised by landmark @NEJM study results as #colonoscopy only reduced #coloncancer incidence by 18% with no significant mortality reduction at 10 yrs. But only 42% had procedure. For those who had colonoscopy, mortality reduced by 50%! #GITwitter nejm.org/doi/full/10.10…

@bens908 @NEJM Death from any cause was 11.03% with colo invitation vs. 11.04% with usual care. But the study was not designed to compare all-cause mortality, only CRC-related deaths. CRC death was 0.28% vs. 0.31% (risk ratio 0.9) in ITT analysis. Per protocol (0.15% vs. 0.30%, risk ratio 0.5).

@JasonDominitz @NEJM What was the absolute risk of death from any cause in both groups? Intention-to-screen and Adjusted per-protocol? (Absolute risk reduction)

@petersliang @DougRobertsonMD Thanks @petersliang! For me, the key take-away messages are that screening only works if you do it, and that #colonoscopy quality is important.

@JasonDominitz @DougRobertsonMD wrote an excellent editorial contextualizing the results

The NordICC trial found *invitation to* colonoscopy (vs no screening) led to 42% colonoscopy uptake, reduced CRC risk by 18%, but did not lower risk of CRC death. It also found *getting a* colonoscopy reduced CRC risk by 31% and risk of CRC death by 50%. Please read this 👇

New editorial by Jason A. Dominitz, M.D., M.H.S., and Douglas J. Robertson, M.D., M.P.H.: "Understanding the Results of a Randomized Trial of Screening Colonoscopy" nej.md/3fBVUi5