Colorectal Cancer Screening: Overview of Existing Programs
Colorectal Cancer Screening: Overview of Existing Programs
CRC incidence and mortality rates vary widely among continents and within continents. High-quality incidence and mortality data allow understanding of disease and are thus the first essential step for effective cancer control planning. In considering whether to move forward with a CRC screening programme, the local impact of the disease relative to other health problems and the capacity to treat the disease adequately should be taken into account. Non-communicable diseases as CRC are rapidly becoming the leading healthcare problem in middle-income and low-income countries. This in particular pertains to those countries that are transitioning to Western lifestyles and have aging populations. Therefore, the need to consider implementing CRC screening beyond the countries in which it is currently taking place is likely to increase over time. Most countries with a high CRC incidence however, already have some form of screening in place.
Despite major changes over the past 15 years, there remain many countries without population-based CRC screening despite high CRC incidence and mortality. This is in most cases explained by limitations in resources including colonoscopy capacity, and the organisation of structure of healthcare delivery. Some countries without an existing programme already have CRC screening on the agenda. This will likely result in implementation of CRC screening in the coming years.
Most organised CRC screening programmes use non-invasive stool tests (FIT or gFOBT), whereas most opportunistic programmes are based on endoscopy, in particular colonoscopy. For both screening strategies, levels of screening uptake vary considerably throughout the world. A screening strategy should be chosen carefully to meet the needs of the applicable screening scenario. A comprehensive understanding of the full range of screening modalities and strategies available for CRC screening is needed for appropriate selection of strategies relative to available financial resources and colonoscopy capacity.
The lack of CRC screening in many countries and the low screening uptake in various others provide room for improvement. In countries with a CRC screening programme with low uptake levels, targeted actions need to be considered to improve uptake. This may include adaptations to the invitation and follow-up protocol, in particular implementing an active call-recall system. Other measures may include a change to or addition of another screening modality. Professional gastroenterology associations may actively promote such changes in close conjunction with health authorities and screening organisations.
Finally, quality assurance and evaluation is of paramount importance to ensure optimal impact, minimal burden and balanced use of resources. Therefore, screening measures and quality indicators should be reported, allowing national evaluation and international comparison to improve CRC screening quality.
In conclusion, the global challenge is to evaluate the need for CRC screening in a given jurisdiction or country, and, if indicated, to develop a tailored CRC screening programme for which the uptake is high. This is especially necessary for low resource countries that face an increase in CRC incidence, as populations adopt a more Westernised lifestyle.
Conclusion
CRC incidence and mortality rates vary widely among continents and within continents. High-quality incidence and mortality data allow understanding of disease and are thus the first essential step for effective cancer control planning. In considering whether to move forward with a CRC screening programme, the local impact of the disease relative to other health problems and the capacity to treat the disease adequately should be taken into account. Non-communicable diseases as CRC are rapidly becoming the leading healthcare problem in middle-income and low-income countries. This in particular pertains to those countries that are transitioning to Western lifestyles and have aging populations. Therefore, the need to consider implementing CRC screening beyond the countries in which it is currently taking place is likely to increase over time. Most countries with a high CRC incidence however, already have some form of screening in place.
Despite major changes over the past 15 years, there remain many countries without population-based CRC screening despite high CRC incidence and mortality. This is in most cases explained by limitations in resources including colonoscopy capacity, and the organisation of structure of healthcare delivery. Some countries without an existing programme already have CRC screening on the agenda. This will likely result in implementation of CRC screening in the coming years.
Most organised CRC screening programmes use non-invasive stool tests (FIT or gFOBT), whereas most opportunistic programmes are based on endoscopy, in particular colonoscopy. For both screening strategies, levels of screening uptake vary considerably throughout the world. A screening strategy should be chosen carefully to meet the needs of the applicable screening scenario. A comprehensive understanding of the full range of screening modalities and strategies available for CRC screening is needed for appropriate selection of strategies relative to available financial resources and colonoscopy capacity.
The lack of CRC screening in many countries and the low screening uptake in various others provide room for improvement. In countries with a CRC screening programme with low uptake levels, targeted actions need to be considered to improve uptake. This may include adaptations to the invitation and follow-up protocol, in particular implementing an active call-recall system. Other measures may include a change to or addition of another screening modality. Professional gastroenterology associations may actively promote such changes in close conjunction with health authorities and screening organisations.
Finally, quality assurance and evaluation is of paramount importance to ensure optimal impact, minimal burden and balanced use of resources. Therefore, screening measures and quality indicators should be reported, allowing national evaluation and international comparison to improve CRC screening quality.
In conclusion, the global challenge is to evaluate the need for CRC screening in a given jurisdiction or country, and, if indicated, to develop a tailored CRC screening programme for which the uptake is high. This is especially necessary for low resource countries that face an increase in CRC incidence, as populations adopt a more Westernised lifestyle.
