European Journal of Epidemiology最新文献

{"title":"The SG90 cohort of the oldest-old in Singapore.","authors":"Lihuan Guan,Lei Feng,Anderson Li Yang Khoo,Kaisy Xinhong Ye,Roger Ho,Tze Pin Ng,Anis Larbi,Brian K Kennedy,Woon-Puay Koh,Yap Seng Chong,Andrea B Maier","doi":"10.1007/s10654-025-01275-0","DOIUrl":"https://doi.org/10.1007/s10654-025-01275-0","url":null,"abstract":"The global population is ageing rapidly. While genetics, lifestyle, and environment are known contributors to healthspan, most insights are drawn from Western cohorts, leaving Asian populations underrepresented despite unique biological, lifestyle, and cultural factors. The SG90 cohort study aimed to fill knowledge gaps in healthy ageing by identifying modifiable medical, biological, lifestyle, psychological, behavioural, and social factors that contribute to longevity in the oldest-old. The study recruited 1,158 participants aged 85 and above from the Singapore Chinese Health Study (SCHS) and Singapore Longitudinal Aging Study (SLAS) between 2015 and 2021. Data collection involved face-to-face interviews to obtain sociodemographic, lifestyle, sleep, functional status, quality of life, medical conditions and healthcare economics information, along with clinical assessments covering physical examinations, anthropometry, physical performance, cognition, and mental health. Biospecimens, including blood, saliva, stool, urine, toenails, hair, and skin tape strips were collected to support extensive multi-omic and cellular analyses. Participants, primarily female (64.5%) and Chinese (97.5%) with a median age of 87 years [interquartile range (IQR): 86-89], were mostly non-smokers (72.1%) and infrequent alcohol consumers (94.9%), with 66.5% exercising regularly. Functional assessments indicate high independence, with median Basic activities of daily living (BADL) and Instrumental ADL (IADL) scores of 20 (IQR: 19-20) and 14 (IQR: 11-16), respectively. 36% of participants rated their self-reported health as good to excellent. The SG90 cohort study offers a comprehensive clinical and biological data resource on healthy ageing among Asia's oldest-old, laying a foundation for targeted interventions to promote healthy longevity and quality of life.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"47 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting closer to each other? Convergence and divergence patterns of life expectancy in 277 border regions of Western Europe 1995-2019.","authors":"Sophie Stroisch,Pavel Grigoriev,Michael Mühlichen,Rok Hrzic,Tobias Vogt","doi":"10.1007/s10654-025-01279-w","DOIUrl":"https://doi.org/10.1007/s10654-025-01279-w","url":null,"abstract":"","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"25 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying multiple sclerosis in women of childbearing age in six European countries: a contribution from the ConcePTION project.","authors":"Marie Beslay,Yvonne Geissbühler,Anna-Belle Beau,Davide Messina,Justine Benevent,Elisa Ballardini,Laia Barrachina-Bonet,Clara Cavero-Carbonell,Alex Coldea,Laura García-Villodre,Anja Geldhof,Rosa Gini,Kerstin Hellwig,Sue Jordan,Maarit K Leinonen,Sandra Lopez-Leon,Marco Manfrini,Visa Martikainen,Vera R Mitter,Amanda J Neville,Hedvig Nordeng,Aurora Puccini,Sandra Vukusic,Joan K Morris,Christine Damase-Michel","doi":"10.1007/s10654-025-01264-3","DOIUrl":"https://doi.org/10.1007/s10654-025-01264-3","url":null,"abstract":"Prevalence of Multiple Sclerosis (MS) has increased over the last decades, primarily among women of childbearing age. Several algorithms for identifying MS have been described in the literature, providing heterogeneous prevalence estimates. We compared five algorithms to identify MS in women of childbearing age and estimated MS prevalence by time period and age-group. The study population included women aged 15 to 49 years-old between 2005 and 2019, from three data sources including all women (from Italy, Norway, and Wales), and three including pregnant women only (from France, Finland, and Spain; data collected around pregnancy). Five algorithms were tested: MS1 to MS3 combined MS diagnoses and MS-medicine prescriptions/dispensations, requiring 1, 2, or 3 occurrences, respectively; MS4 and MS5 used only MS diagnoses, requiring at least 2 occurrences (MS4 allowed just 1 if diagnosis was from inpatient care). In 2015-2019, MS prevalence based on MS1 ranged from 109 to 359 per 100,000 women: 109 in France, 121 in Spain, 195 in Wales, 232 in Finland, 264 in Italy, and 359 in Norway. More restrictive algorithms led to greater disparity, with MS3 ranging from 53 in Spain to 325 in Norway, and MS5 from 21 in France to 345 in Norway. All algorithms showed expected prevalence trends by time and age among women of childbearing age, though lower than in the literature. Overall, MS1 provided prevalence estimates most closely aligned with existing literature. This study offers key insights into choosing algorithms for identifying MS in women of childbearing age and in pregnant women.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"30 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plant-based dietary patterns and breast cancer risk in the European prospective investigation into cancer and nutrition (EPIC) study.","authors":"Sanam Shah,Nasser Laouali,Yahya Mahamat-Saleh,Carine Biessy,Geneviève Nicolas,Sabina Rinaldi,Raul Zamora-Ros,Nikos Papadimitriou,Fernanda Morales-Berstein,Christina C Dahm,Anne Kristine Lundgård Christensen,Lene Mellemkjaer,Anne Marie Overgaard Nielsen,Francesca Romana Mancini,Xuan Ren,Chloé Marques,Verena Katzke,Charlotte Le Cornet,Christine El-Khoury,Matthias B Schulze,Claudia Agnoli,Vittorio Simeon,Rosario Tumino,Lorenzo Milani,Carlota Castro-Espin,Maria-Jose Sánchez,Amaia Aizpurua,Sandra M Colorado-Yohar,Marcela Guevara,Alicia Heath,Dagfinn Aune,Heinz Freisling,Inge Huybrechts,Laure Dossus","doi":"10.1007/s10654-025-01277-y","DOIUrl":"https://doi.org/10.1007/s10654-025-01277-y","url":null,"abstract":"While previous literature suggests that plant-based diets may be associated with a lower risk of breast cancer, evidence remains inconsistent. In this study, we investigated the association between adherence to plant-based diets and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Overall plant-based diet index (PDI), healthful (hPDI), and unhealthful PDI (uPDI) were calculated, and multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of breast cancer for the three indices. Mediation analysis was performed to assess the role of body mass index (BMI) and waist circumference (WC) in the association between hPDI and postmenopausal breast cancer risk. Over a median follow-up of 14.9 years, 10,805 incident invasive breast cancer cases were identified among 258,343 women. In the multivariable model, not adjusted for BMI, higher adherence to hPDI was inversely associated with breast cancer risk, with HR per 1-SD increase [95% (CI)] of 0.97 (0.94, 0.99). The corresponding HRs (95% CI) per 1-SD increase for overall PDI and uPDI were 0.98 (0.96, 1.00) and 1.01 (0.99, 1.03), respectively. The associations between hPDI and postmenopausal breast cancer were partly explained by BMI and WC, which mediated 30% and 52% of this association, respectively. Higher adherence to hPDI was associated with a slightly lower total breast cancer risk. For postmenopausal breast cancer, this association was partly explained by lower BMI or WC. These findings suggest that promoting healthful plant-based diets could support breast cancer risk reduction.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"45 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A phenome-wide association study of genetically determined nicotine metabolism reveals novel links with health-related outcomes.","authors":"Jadwiga Buchwald, Terho Lehtimäki, Olli Raitakari, Veikko Salomaa, Jaakko Kaprio, Matti Pirinen","doi":"10.1007/s10654-025-01270-5","DOIUrl":"https://doi.org/10.1007/s10654-025-01270-5","url":null,"abstract":"<p><p>Faster nicotine metabolism, defined as the nicotine metabolite ratio (NMR), is known to associate with heavier smoking and challenges in smoking cessation. However, the broader health implications of genetically determined nicotine metabolism are not well characterized. We performed a hypothesis-free phenome-wide association study (PheWAS) of over 21,000 outcome variables from UK Biobank (UKB) to explore how the NMR (measured as the 3-hydroxycotinine-to-cotinine ratio) associates with the phenome. As the exposure variable, we used a genetic score for faster nicotine metabolism based on 10 putative causal genetic variants, explaining 33.8 % of the variance in the NMR. We analysed ever and never smokers separately to assess whether a causal pathway through nicotine metabolism is plausible. A total of 57 outcome variables reached phenome-wide significance at a false discovery rate of 5 %. We observed expected associations with several phenotypes related to smoking and nicotine, but could not replicate prior findings on cessation. Importantly, we found novel associations between genetically determined faster nicotine metabolism and adverse health outcomes, including unfavourable liver enzyme and lipid values, as well as increased caffeine consumption. These associations did not appear to differ between ever and never smokers, suggesting the corresponding pathways may not involve nicotine metabolism. No favourable health outcomes were linked to genetically determined faster nicotine metabolism. Our findings support a possibility that a future smoking cessation therapy converting fast metabolizers of nicotine to slower ones could work without adverse side effects and potentially even provide other health-related benefits.</p>","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 infection increases the risk of venous thromboembolism during pregnancy and the postpartum period.","authors":"Anne K Örtqvist,Jonas Söderling,Maria C Magnus,Stine Kjaer Urhoj,Siri E Håberg,Olof Stephansson","doi":"10.1007/s10654-025-01268-z","DOIUrl":"https://doi.org/10.1007/s10654-025-01268-z","url":null,"abstract":"Pregnant and puerperal women are at increased risk of venous thromboembolism (VTE) owing to hemostatic changes in preparation for childbirth. The objective of this study was to investigate if COVID-19 infection was associated with VTE in pregnancy or 12 weeks postpartum when considering (prophylactic or therapeutic) anticoagulant use. This population-based register study included all women in Sweden and Norway giving birth after 22 gestational weeks, with conception dates from March 2020 to 2022. A PCR-verified COVID-19 test was used as the exposure, and a VTE diagnosis during pregnancy or 12 weeks postpartum was the outcome. Non-infected women consisted of those testing negative and untested individuals. Cox regression analyses, with COVID-19 infection as a time-varying exposure, and adjusted for maternal characteristics and anticoagulant use, provided overall hazard ratios. To evaluate whether there was a particular increased risk of VTE shortly after testing positive for COVID-19, we estimated time-specific risk of VTE in the first 2, 4, 8, 12, and 16 weeks following COVID-19 infection. Data from each country were first analyzed separately and then meta-analyzed. Among 323,868 participants, 46,048 (14.2%) had COVID-19 during pregnancy, and 80 (0.2%) were diagnosed with VTE. Pregnant women with COVID-19 had a higher VTE incidence rate compared to non-infected (4.9 vs. 2.9 per 1000 person-years; adjusted overall hazard ratio [aHR] 1.26, 95% Confidence Interval [CI] 0.80-2.00). The highest risk was within two weeks of infection (aHR 4.63, 95% CI 2.71-7.90) but remained elevated up to 12 weeks post-infection (aHR 1.86, 95% CI 1.17-2.94). In the postpartum period, 8,515 (2.6%) had COVID-19, and 6 (0.07%) were diagnosed with VTE (aHR 5.17, 95% CI 2.50-10.69). Although VTE post-COVID-19 infection was rare, the infection was associated with increased VTE risk during pregnancy and postpartum, even after adjusting for anticoagulant use. These findings should contribute to the individual risk assessment when evaluating the need for prophylactic anticoagulants in pregnancy and postpartum.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"4 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hormonal contraceptive use and anaemia: a nation-wide pharmacoepidemiological study from Northern Europe.","authors":"Sofie Ekroos,Elena Toffol,Oskari Heikinheimo,Jari Haukka,Mikko Arvas","doi":"10.1007/s10654-025-01272-3","DOIUrl":"https://doi.org/10.1007/s10654-025-01272-3","url":null,"abstract":"The WHO aims to reduce iron deficiency anaemia globally. Use of modern hormonal contraception (HC) could offer protection against anaemia in premenopausal women, but population-level effectiveness is unclear. We aim to quantify the effect of HC on anaemia. This nested case-control study includes over half the fertile-aged female population of Finland in 2017. Data on HC use from the national Prescription Center were combined with data on anaemia diagnosis from national care registries. Cases (anaemia diagnosis during follow-up, 2019-2020) were matched with up to five controls by age and municipality. After calculating the minimally sufficient adjustment set, adjusted odds ratios were derived in a conditional multivariable regression model accounting for matching. 3 100 cases of anaemia were matched with 13 143 controls. The minimally sufficient adjustment set included age, education level, obesity, abnormal uterine bleeding, and cancer. Compared to non-users of HC, risk of anaemia was lower in users of combined oral contraceptives containing ethinylestradiol (0·74 [0·66-0·83]) or oestradiol (0·49 [0·35-0·68]), progestin-only oral contraceptives (0·42 [0·35-0·51]), LNG-IUDs (0·64 [0·43-0·94]), and contraceptive vaginal rings (0·68 [0·49-0·94]). Individual product effects ranged from 0·77 [0·66-0·90] for drospirenone and ethinylestradiol to 0·40 [0·32-0·48] for desogestrel-only. Benefits of HC use extend to anaemia protection on population level. Anaemia protection should be included in guidelines on HC to support clinical decision making.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"72 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144594238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral contraceptive use increases bone density and reduces the risk of osteoporosis.","authors":"Emma L Ivansson,Therese Johansson,Torgny Karlsson,Åsa Johansson","doi":"10.1007/s10654-025-01273-2","DOIUrl":"https://doi.org/10.1007/s10654-025-01273-2","url":null,"abstract":"Osteoporotic fractures, largely resulting from reduced estrogen levels after menopause and subsequent bone loss, are a leading cause of disability among older women. Although oral contraceptive pills (OCPs) contain estrogen, their long-term impact on bone health and osteoporosis risk remain uncertain. Here, we assessed the effect of OCP use on bone mineral density (BMD) and osteoporosis using data from 257,185 women from the UK Biobank, born 1936-1970. Time-dependent Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for osteoporosis, while multivariable linear regression was used to assess the effect of OCP use on BMD, measured as T-scores in standard deviation units based on quantitative ultrasound of the calcaneus. By the end of follow-up in 2020, 7.6% of the participants had received an osteoporosis diagnosis. The rate of osteoporosis was lower among ever OCP users (HR = 0.86; 95% CI 0.83-0.89; P = 2.8 × 10-17). OCP use was also associated with a higher BMD T-score (0.052; 0.038-0.067; P = 2.1 × 10-12) with an increasing effect with longer use. Use of OCPs for 0-1 years had no significant effect on BMD (P = 0.081). However, longer durations were associated with increased BMD T-scores compared to never users: 2-5 years (0.046; 0.027-0.065, P = 2.2 × 10-6), 6-10 years (0.062; 0.043-0.080; P = 3.5 × 10-12), 11-15 years (0.062; 0.042-0.081; P = 3.2 × 10-12) and 16 + years (0.064; 0.044-0.083; P = 1.2 × 10-10). We found prior OCP use to be associated with higher BMD and a reduced risk of osteoporosis, potentially offering long-term benefits and suggesting that OCP use could reduce osteoporotic complications in older women.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"72 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Cancer Information Grand Round for Survivorship (BIG-S) prospective cohort.","authors":"Danbee Kang,Juwon Park,Hyunsoo Kim,Jeong Eon Lee,Seok Jin Nam,Seok Won Kim,Jonghan Yu,Byung Joo Chae,Jai Min Ryu,Juhee Cho,Se Kyung Lee","doi":"10.1007/s10654-025-01262-5","DOIUrl":"https://doi.org/10.1007/s10654-025-01262-5","url":null,"abstract":"Existing evidence indicates that long-term effects of breast cancer treatment can significantly impact survivors' ability to fulfill their personal, familial, and social roles. However, few studies comprehensively integrate patient-reported outcomes (PROs) and real-world healthcare utilization data, particularly in Asian populations. Thus, we established a prospective cohort, the Breast Cancer Information Grand Round for Survivorship (BIG-S), to address these gaps and introduce this resource. The prospective BIG-S cohort recruited patients newly diagnosed with breast cancer at Samsung Medical Center starting in November 2018. Clinical data, recurrence, and healthcare utilization were systematically collected from electronic medical records by trained researchers, and body composition was measured using multifrequency bioelectrical impedance analysis. PROs were assessed following recommendations from the International Consortium for Health Outcomes Measurement (ICHOM). These included health-related quality of life, physical, psychological, social, and cognitive functions, symptoms, healthy behaviors, financial difficulty, spiritual well-being, and cancer adaptation, using validated questionnaires. A total of 2,749 patients participated, with an average age of 49.7 years. The mean quality-of-life score at diagnosis was 55.6, indicating moderate general well-being, and improved gradually to 68.2 at four years post-diagnosis. At baseline, participants showed high physical, cognitive, and role functioning scores but had relatively lower emotional and social functioning scores. Over four years, emotional and social functioning improved, whereas cognitive and role functioning declined. Survivors initially reported low sexual functioning, sexual enjoyment, and future perspectives, all of which significantly decreased during follow-up. Fatigue and insomnia were persistent throughout the observation period. Healthcare utilization initially concentrated on plastic surgery and rehabilitation medicine and increasingly shifted towards gynecology, family medicine, and psychiatry after two years. The BIG-S cohort uniquely integrates clinical data, PROs, and healthcare utilization patterns, offering comprehensive insights into breast cancer survivorship trajectories. Findings from BIG-S are expected to guide targeted interventions and inform tailored survivorship care strategies, especially for Asian breast cancer survivors.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"106 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Looking at randomized trials with the critical eyes of epidemiologists: the case of screening colonoscopy.","authors":"Hermann Brenner,Thomas Heisser,Michael Hoffmeister","doi":"10.1007/s10654-025-01269-y","DOIUrl":"https://doi.org/10.1007/s10654-025-01269-y","url":null,"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.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"3 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}