A groundbreaking study led by researchers from Uppsala University and Karolinska Institutet has delivered promising evidence that colorectal cancer screening significantly enhances the early detection of the disease, potentially transforming the clinical approach to one of the world’s deadliest malignancies. Encompassing data from over 278,000 individuals aged 60, this rigorous randomized controlled trial compares the efficacy of two distinct screening methods—primary colonoscopy and fecal immunochemical testing (FIT)—against the backdrop of usual clinical care without screening. The findings, published in Nature Medicine, not only underscore the vital role of screening in catching colorectal cancer at its most treatable stages but also suggest an encouraging trend toward preventive intervention through early adenoma detection and removal.
Colorectal cancer remains a pervasive global health challenge, ranking consistently among the leading causes of cancer-related mortality. The disease’s insidious progression often results in diagnoses at late stages when therapeutic options are limited and prognoses grim. Recognizing this critical gap, the study meticulously evaluated whether systematic screening practices could shift diagnosis timelines earlier, thereby increasing survival rates and decreasing the burden of advanced disease. Researchers drew participants from the general Swedish population, randomizing them into three cohorts: those invited directly for colonoscopy, those offered two rounds of FIT followed by colonoscopy contingent on positive fecal blood findings, and a control group receiving standard care without screening intervention.
Within the FIT group, individuals collected stool samples at home, which underwent quantitative analysis for occult blood—a biomarker with established sensitivity for colorectal neoplasia. A threshold of 10 micrograms of hemoglobin per gram of feces was designated for positivity, triggering subsequent colonoscopy to confirm the presence of malignancy or precancerous lesions. The dual rounds of FIT screening, administered at one and three years, were strategically designed to enhance detection windows while balancing patient compliance and resource allocation. The colonoscopy arm received a once-only invitation for endoscopic examination, a method traditionally lauded for comprehensive mucosal inspection albeit with higher invasiveness and demand on clinical resources.
Statistical analysis revealed a significant uptick in the diagnosis of early-stage colorectal cancer in both screened cohorts compared to the control group, with an especially pronounced impact observed in the FIT arm. Over the study period extending to 2020, participants undergoing FIT screening exhibited a colorectal cancer incidence of 0.61%, whereas those under usual care presented with 0.73%, illustrating a tangible reduction in disease burden attributable to early detection and intervention. The protective effect is attributed in part to the identification and excision of adenomatous polyps—benign precursors with malignant transformation potential—during colonoscopic follow-up, thereby intercepting carcinogenesis at a critical juncture.
In addition to efficacy, the study rigorously monitored safety endpoints associated with the increased use of colonoscopy prompted by positive FIT results. While a marginal increase in gastrointestinal bleeding and thromboembolic events was noted during the initial year of follow-up, these complications remained infrequent and did not translate into elevated all-cause mortality. This risk profile provides reassurance regarding the balance between potential harms and the substantial benefits conferred by early cancer identification. It also emphasizes the importance of meticulous patient selection, standardized procedural protocols, and vigilant post-procedure monitoring within population-wide screening initiatives.
The magnitude and robustness of this investigation are amplified by its unprecedented scale and randomized design, positioning it as a pivotal contribution to colorectal cancer screening literature. By encompassing a demographic reflective of routine clinical screening candidates, the findings are directly translatable into national healthcare policies. The Swedish SCREESCO trial, initiated in 2014, thus furnishes compelling evidence to bolster ongoing efforts to optimize colorectal cancer screening paradigms, informing guidelines aimed at reducing mortality through tailored, evidence-based interventions.
Moreover, the study’s longitudinal follow-up, planned through 2030, is poised to yield invaluable insights into the long-term mortality benefits and cost-effectiveness of the screening modalities tested. Such outcome data will be critical in refining screening intervals, stratifying patient risk, and potentially integrating emerging biomarkers or novel technologies to augment diagnostic precision. The durability of early detection benefits and the mitigation of fatal outcomes will ultimately solidify the role of these screening strategies within comprehensive cancer control frameworks.
An additional noteworthy dimension of this trial is the differential operational feasibility and patient acceptance associated with each screening method. Though colonoscopy serves as the diagnostic gold standard, its invasiveness, requisite bowel preparation, and resource intensity constrain scalability across large populations. Conversely, FIT offers a non-invasive, cost-efficient alternative amenable to repeated home-based sampling, which may enhance participation rates and contribute to earlier diagnosis on a population scale. The study’s data highlight that deploying FIT as a frontline screening tool with subsequent targeted colonoscopy can strike an optimal balance between clinical efficacy and pragmatic implementation.
Importantly, the SCREESCO study’s findings have profound implications for global colorectal cancer screening policies beyond Sweden. Variability in screening recommendations and uptake internationally underscores the necessity for robust evidence supporting specific methodologies tailored to healthcare infrastructure and patient populations. This rigorous trial, with its comprehensive design and extensive follow-up, serves as a benchmark for large-scale population health interventions against colorectal cancer and informs a blueprint for harmonizing screening practices worldwide.
In synthesis, the SCREESCO trial substantiates that both colonoscopy and fecal immunochemical testing significantly improve early-stage colorectal cancer detection relative to usual care, with the FIT approach demonstrating a measurable reduction in advanced cancer incidence. These findings validate screening as a cornerstone in colorectal cancer prevention and early management, heralding a future where timely intervention could substantially curtail the morbidity and mortality attributable to this disease. As the trial continues to mature, the anticipated mortality data will be pivotal in establishing definitive screening recommendations and reinforcing the life-saving potential of proactive colorectal cancer surveillance.
The integration of these insights into clinical practice emphasizes a paradigm shift, where balancing diagnostic sensitivity, patient-centered approaches, and resource stewardship guides comprehensive cancer screening. The SCREESCO trial’s contributions resonate profoundly within the oncological and public health communities, affirming that systematic, evidence-based screening strategies are essential weapons in the global fight against colorectal cancer.
Subject of Research: People
Article Title: Colonoscopy and fecal immunochemical testing versus usual care in diagnostic colorectal cancer screening: the SCREESCO randomized controlled trial
News Publication Date: 20-Feb-2026
Web References:
https://doi.org/10.1038/s41591-026-04225-9
References:
SCREESCO randomized controlled trial, Nature Medicine, 2026
Image Credits:
Mikael Wallerstedt / Uppsala University
Keywords:
Colorectal cancer, screening, colonoscopy, fecal immunochemical test, FIT, early detection, adenoma, randomized controlled trial, SCREESCO, cancer prevention, population health, diagnostic methods
