ColorectalScreen Norway: A program for early detection of colorectal cancer

ColorectalScreen Norway has recently been implemented nationwide. The goal of the program is to reduce colorectal cancer-related mortality, by identifying cases at an early stage when treatment is most effective.

The screening program was launched in 2022 and has gradually been implemented across the country. Full nationwide coverage was achieved in January 2024. The program offers a free screening test to men and women between 55 and 65 years old. The first invitations were sent to individuals born in 1967, and each year, new birth cohorts are added. The invitation is repeated every second year.

ColorectalScreen Norway is managed by the Cancer Registry of Norway, which operates under the Norwegian Institute of Public Health. The Norwegian Directorate of Health oversees the program’s activities and lead the steering group for national cancer screening programs.

How ColorectalScreen Norway works

The primary screening test used is the immunochemical fecal occult blood test (FIT), which detects blood in stool. The test is easy to perform and is conducted at home. Once a person turns 55, they first receive an invitation digitally, followed by the delivery of a sample kit by mail. This kit includes a stool sample tube, instructions, and a return envelope. Participants collect the sample at home and return it to the laboratory for analysis. All stool samples are analyzed at one central laboratory at Akershus University Hospital.

The sample kit sent to participants. Photo: Kreftregisteret

Participants receive their test results digitally. If the FIT is negative (blood levels below the defined threshold), the participant will be sent a new test kit every two years until they turn 65. In case of a positive FIT, the participant will be referred for a colonoscopy at the local hospital, where doctors can examine the colon for cancer or precancerous polyps.

Key insights from the screening pilot

Prior to the national screening program, a 12-year pilot trial was conducted in the eastern part of Norway, involving 140,000 individuals. This study provided key insights into the best approach for a national screening program for colorectal cancer in Norway. The pilot compared two screening methods: the FIT and sigmoidoscopy, a procedure that examines the lower part of the colon.

Results showed that 70% of those invited completed at least one round of FIT, while participation in the sigmoidoscopy group was slightly above 50%. More colorectal cancer cases and advanced polyps were found in the FIT group. In total, more than 500 cases of colorectal cancer and 4,000 cases of advanced polyps were detected in the pilot study. More than 70% of cancer cases were found at an early stage, associated with a good prognosis. The study confirmed that repeated FIT screenings were effective in detecting early-stage cancers, which could significantly improve outcomes.

The pilot also played a crucial role in training gastroenterologists. Many doctors who specialized in colonoscopy procedures during the study now contribute to the national screening program, strengthening Norway’s capacity to reduce the burden of colorectal cancer.

The impact of early detection and preliminary results

Colorectal cancer is one of the most common cancers in Norway, affecting 4,500 people each year, with around 1,600 deaths annually. By detecting cancer early, the risk of dying from the disease decreases significantly. It is estimated that participating in the screening program can reduce the mortality of colorectal cancer by at least 25%.

Since the launch of the national program, 240 000 people have been invited to participate, so far the participation is about 54%. Around 6 % of participants receive a positive test result. Among participants undergoing colonoscopy about 50% will have polyps removed.

The colorectal screening program is still new, and we are working to raise awareness among the population. As the program becomes more known to the public, this will hopefully increase participation.

Insights for other European screening programs

Norway’s experience can provide useful insights for countries looking to strengthen their colorectal cancer screening programs. Important factors include:

– A strong foundation, built on insights from a large-scale pilot trial.
– A national set up for distribution of the primary screening test, allowing accessibility and ease of use.
– Centralized monitoring, enabling efficiency in analyzing test results.
– Colonoscopy is used to diagnose colorectal cancer and as a preventive measure by detecting and removing precancerous polyps that could develop into cancer.
– Colonoscopy training offered through the Norwegian endoscopy school.

By sharing experiences from ColorectalScreen Norway, we aim to support and inspire international colleagues in their efforts to reduce colorectal cancer mortality through effective, population-based screening programs.

For more information, visit: ColorectalScreen Norway

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Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or European Health and Digital Executive Agency (HADEA). Neither the European Union nor HADEA can be held responsible for them.

The general objective of EUCanScreen is to assure sustainable implementation of high-quality screening for breast, cervical and colorectal cancers, as well as implementation of the recently recommended screening programs – for lung, prostate and gastric cancers. EUCanScreen will facilitate the reduction of cancer burden and achieving equity across the EU.

This project has received funding from the European Union’s EU4HEALTH Programme under the Grant Agreement no 101162959