153654 20251017144558.0 doi 10.1016/S0140-6736(25)00145-X sideral 143785 ART-2025-143785 eng Castells, Antoni Effect of invitation to colonoscopy versus faecal immunochemical test screening on colorectal cancer mortality (COLONPREV): a pragmatic, randomised, controlled, non-inferiority trial 2025 Background: Colonoscopy and the faecal immunochemical test are accepted strategies for colorectal cancer screening in the average-risk population (ie, people aged ≥50 years without personal or family history of colorectal cancer). In this trial, we aimed to compare whether invitation to screening with faecal immunochemical test was non-inferior to colonoscopy in a screening programme. Methods: COLONPREV was a pragmatic, randomised, controlled, non-inferiority trial done at 15 tertiary hospitals across eight regions of Spain. Eligible participants were presumptively healthy and aged between 50 years and 69 years without a personal history of colorectal cancer, adenoma or inflammatory bowel disease, family history of hereditary or familial colorectal cancer (ie, two or more first-degree relatives with colorectal cancer or one diagnosed before age 60 years), severe comorbidities, or previous colectomy. Participants were randomly assigned (1:1) to one-time colonoscopy or biennial faecal immunochemical test before invitation to screening. The primary endpoint was colorectal cancer mortality at 10 years, assessed in the intention-to-screen population. An absolute difference of less than 0·16 percentage points was required to show non-inferiority. This trial was registered with ClinicalTrials.gov, NCT00906997. Findings: Between June 1, 2009, and Dec 31, 2021, 57 404 individuals were randomly assigned to receive an invitation for colonoscopy (n=28 708) or the faecal immunochemical test (n=28 696). The intention-to-screen population consisted of 26 332 individuals in the colonoscopy group and 26 719 in the faecal immunochemical test group. In the intention-to-screen population, participation in any form of screening was 31·8% in the colonoscopy group and 39·9% in the faecal immunochemical test group (risk ratio [RR] 0·79 [95% CI 0·77 to 0·82]). Faecal immunochemical testing was non-inferior to colonoscopy with regard to the risk of colorectal cancer mortality at 10 years: the risk was 0·22% (55 deaths) in the colonoscopy group and 0·24% (60 deaths) in the faecal immunochemical test group (risk difference -0·02 [95% CI -0·10 to 0·06; RR 0·92 [95% CI 0·64 to 1·32]; pnon-inferiority=0·0005). Interpretation: Participation in screening was higher among individuals invited to faecal immunochemical test screening than colonoscopy screening. On the basis of participation observed in this study, a faecal immunochemical test-based programme was non-inferior to a colonoscopy-based programme for colorectal cancer-related mortality. info:eu-repo/grantAgreement/ES/ISCIII/CD22-00087 info:eu-repo/grantAgreement/ES/ISCIII/FI22-00203 info:eu-repo/grantAgreement/ES/ISCIII/INT22-00009 info:eu-repo/grantAgreement/ES/ISCIII/PI08-90717 info:eu-repo/semantics/closedAccess All rights reserved http://www.europeana.eu/rights/rr-f/ info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Quintero, Enrique Bujanda, Luis Castán-Cameo, Susana Cubiella, Joaquín Díaz-Tasende, José Lanas, Ángel Universidad de Zaragoza (orcid)0000-0001-5932-2889 Akiko, Ono Serra-Burriel, Miquel Frías-Arrocha, Eladio Hernández, Cristina Jover, Rodrigo Andreu, Montserrat Carballo, Fernando Morillas, Juan Diego Salas, Dolores Almazán, Raquel Alonso-Abreu, Inmaculada Banales, Jesús M. Hernández, Vicent Portillo, Isabel Vanaclocha-Espí, Mercedes Vega, Mariola de la COLONPREV study investigators 1007 610 Universidad de Zaragoza Dpto. Medicina, Psiqu. y Derm. Area Medicina 405, 10486 (2025), 1231-1239 Lancet The Lancet 0140-6736 868409 http://zaguan.unizar.es/record/153654/files/texto_completo.pdf Versión publicada 3102736 http://zaguan.unizar.es/record/153654/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:153654 articulos driver 2025-10-17-14:13:41 ARTICLE