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@ARTICLE{Brenner:302821,
      author       = {H. Brenner$^*$ and T. Heisser$^*$ and M. Hoffmeister$^*$},
      title        = {{L}ooking at randomized trials with the critical eyes of
                      epidemiologists: the case of screening colonoscopy.},
      journal      = {European journal of epidemiology},
      volume       = {40},
      number       = {8},
      issn         = {0393-2990},
      address      = {[Cham]},
      publisher    = {Springer Nature Switzerland AG},
      reportid     = {DKFZ-2025-01361},
      pages        = {881-889},
      year         = {2025},
      note         = {#EA:C070#LA:C070# / 2025 Aug;40(8):881-889},
      abstract     = {Based on compelling evidence from observational
                      epidemiological studies, screening colonoscopy has since
                      long been thought to strongly lower the burden of colorectal
                      cancer (CRC), 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 (RCT) 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. Such reasoning was based
                      on the trust that randomization in this large-sized trial
                      should have prevented any residual confounding that might
                      have affected the observational epidemiological studies.
                      However, randomization cannot prevent other potential biases
                      which should be carefully addressed and minimized in both
                      observational and interventional studies. We illustrate that
                      such biases may have led to major underestimation of
                      screening effects in the NordICC trial. 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.},
      cin          = {C070 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)HD01-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40627067},
      doi          = {10.1007/s10654-025-01269-y},
      url          = {https://inrepo02.dkfz.de/record/302821},
}