Nat Med

Colonoscopy and FIT yield comparable cancer detection but carry higher early‑phase risks

February 23, 2026

In the large, Swedish randomized SCREESCO trial (NCT02078804) involving more than 278,000 adults, both once‑only colonoscopy and two‑round FIT screening increased early‑stage colorectal cancer (CRC) detection compared with usual care. After a median 4.8 years, overall CRC incidence rates were similar between colonoscopy and control groups (incidence rate ratio [IRR], 1.08; 95% confidence interval [CI], 0.91–1.28) and slightly lower in the FIT group (IRR, 0.92; 95% CI, 0.81–1.05). Early‑stage (stage I–II) cancers were detected more frequently with screening, with colonoscopy showing an IRR of 1.38 (95% CI, 1.09–1.74) and FIT showing an IRR of 1.19 (95% CI 0.99–1.43) versus controls. Adverse events, including cardiovascular and GI complications, were modestly increased during the first year in both intervention groups before returning to baseline levels similar to usual care thereafter.

Clinical takeaway: Encourage eligible adults to undergo CRC screening. FIT offers strong participation and efficiency, while colonoscopy maximizes detection of early‑stage disease, with awareness of small, early transient increases in GI and cardiovascular events.

Source:

Westerberg M, et al. (2026, February 20). Nat Med. Colonoscopy and fecal immunochemical testing versus usual care in diagnostic colorectal cancer screening: the SCREESCO randomized controlled trial. https://pubmed.ncbi.nlm.nih.gov/41721101/