We have established an infrastructure for population-based colorectal cancer screening that compares two screening modalities in a randomised design. We have also established a structured training system for endoscopy that is also extendable to endoscopy training for clinical practice.
The BCSN pilot project aims to generate important new knowledge about colorectal cancer screening. It may also measure the effects of systematic endoscopy training. The project will help to indicate the best screening test for the Norwegian population, based on solid methodology in the form of a randomised comparative effectiveness study. Four papers from sub-studies on lifestyle and psychological reactions have already been published (15)-(18).
The design of the project was based on the political decision that long-term implementation of bowel cancer screening should be evidence-based. This may strengthen Norway’s leading international role in research on colorectal cancer screening.
The preliminary results from this pilot project and the preceding Norwegian Colorectal Cancer Prevention (NORCCAP) project (8), have formed the basis for the recommendation by the Norwegian National Council for Priority Setting in Health Care on implementation of a national programme for bowel cancer screening (19).
New colorectal cancer screening tests are evolving and need testing as part of a population-based programme in the years to come. A future screening programme should be an arena for systematic testing of new methods (20).
We also plan to test other population-oriented prevention measures as part of the bowel screening programme, such as information and advice on beneficial lifestyle. This may reduce the incidence of several lifestyle diseases. We have fulfilled the requirements of the Norwegian National Council for Priority Setting in Health Care (14) by avoiding placing an undue burden on regular clinical practice. On the contrary, the pilot project entailed recruitment of new gastroenterologists and endoscopy nurses by establishing a regional centre for structured endoscopy training. In total, 22 endoscopists from 13 hospitals in South-Eastern Norway Regional Health Authority were trained and certified as colonoscopy trainers and will cover much of the need for endoscopy training in the region. International experience indicates that the need would probably have been met had half of the endoscopists taken the course.