Impact of organised colorectal cancer screening on age-specific population incidences: evidence from a quasi-experimental study in Sweden

Colorectal cancer (CRC) incurs a significant disease burden globally. Organised CRC screening programmes have been widely implemented for early detection and prevention. To understand the public health impact of these programmes, quantitative evidence of changes in overall and age-specific population incidences is fundamental. We aimed to provide such evidence by exploiting a time lag in the implementation of organised screening in Sweden: two out of 21 regions (these two regions comprise nearly 20% of the total Swedish population) have offered organised screening since 2008; the other regions have offered CRC screening since 2021. Using registry data on diagnosed CRC cases and socio-demographics for all regions in Sweden over the period 1970–2019, Bayesian structural time series modelling and difference-in-differences were applied to analyse the impact of screening on age-specific population incidences over time (CRC cases per 100.000 persons/year). After inviting birth-year cohorts aged 60–69 years for stool-based testing, the incidence rate in the 70–74-year age group decreased significantly over time, with an average reduction of − 44·40 (95% CI − 58·15 to − 31·31) from 2011 to 2019 in the intervention regions. In the overall population aged 60–74 years, there was a net incidence decrease of − 7·99 (95% CI − 13·85 to − 2·39) since the initiation of organised screening in the intervention regions (2008–2019). Organised CRC screening for 60–69-year-olds generated a change in age-specific incidence patterns with a long-lasting incidence decrease in the 70–74-year-old population, implying reductions in the excess mortality and burden of the disease.