Based on compelling evidence from observational epidemiological studies, screening colonoscopy has since long been thought to strongly lower the burden of colorectal cancer, both by early detection of prevalent CRC and prevention of incident CRC through detection and removal of precancerous lesions. Widespread offer and use of screening colonoscopy went along with a dramatic decline in CRC incidence in screening age groups in the US, in contrast to an increase in incidence at younger ages and in countries not engaging in CRC screening. The recently published 10-year results from the NordICC trial, the first randomized clinical trial reporting long-term effects of screening colonoscopy on CRC risk and mortality, has been widely interpreted as challenging the evidence for strong efficacy of screening colonoscopy. The observed patterns underline the need for more rigorous efforts to prevent and correct for such biases, along with the need to derive more informative metrics of screening efficacy. Such metrics should include informative estimates of screening colonoscopy effects on both early detection of prevalent CRC cases and prevention of incident CRC cases. The momentum for CRC screening should by no means slowed by misinterpretation of the NordICC trial evidence.

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The scientists here demonstrate the utility of using multiple biomarkers to probe these biological systems, paving the way for future research to explore how these systems change across diverse neurodegenerative conditions.

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