Download PDF
Endoscopy 2013; 45(01): 51-59
DOI: 10.1055/s-0032-1325997
Guidelines
© Georg Thieme Verlag KG Stuttgart · New York

European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

European Colorectal Cancer Screening Guidelines Working Group:
Further Information

Publication History

submitted 10 October 2012

accepted after revision 26 October 2012

Publication Date:
04 December 2012 (online)

Also available at
   Permissions and Reprints

Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010. They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.

† Deceased


 

  • References

  • 1 Ferlay J, Shin HR, Bray F et al. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available at: http://globocan.iarc.fr Accessed: Sept 9 2012
    Search in Google Scholar
  • 2 von Karsa L, Lignini TA, Patnick J et al. The dimensions of the CRC problem. Best Pract Res Clin Gastroenterol 2010; 24: 381-396
    CrossrefPubMedSearch in Google Scholar
  • 3 Lansdorp-Vogelaar I, von Karsa L. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Introduction. Endoscopy 2012; 44 : SE15-SE30
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Atkin WS, Edwards R, Kralj-Hans I et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 2010; 375: 1624-1633
    CrossrefPubMedSearch in Google Scholar
  • 5 Mandel JS, Church TR, Bond JH et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med 2000; 343: 1603-1607
    CrossrefPubMedSearch in Google Scholar
  • 6 Segnan N, Armaroli P, Bonelli L et al. Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian Randomized Controlled Trial – SCORE. J Natl Cancer Inst 2011; 103: 1310-1322
    CrossrefPubMedSearch in Google Scholar
  • 7 Schoen RE, Pinsky PF, Weissfeld JL et al. Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med 2012; 366: 2345-2357
    CrossrefPubMedSearch in Google Scholar
  • 8 Hardcastle JD, Chamberlain JO, Robinson MH et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996; 348: 1472-1477
    CrossrefPubMedSearch in Google Scholar
  • 9 Kronborg O, Fenger C, Olsen J et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996; 348: 1467-1471
    CrossrefPubMedSearch in Google Scholar
  • 10 Mandel JS, Church TR, Ederer F et al. Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood. J Natl Cancer Inst 1999; 91: 434-437
    CrossrefPubMedSearch in Google Scholar
  • 11 Council of the European Union. Council Recommendation of 2 December 2003 on cancer screening (2003/878/EC). Off J Eur Union 2003; 34-38
    PubMedSearch in Google Scholar
  • 12 Wilson JMG, Jungner G. Principles and practice of screening for disease. Geneva, Switzerland: WHO; 1968. Available at: http://whqlibdoc.who.int/php/WHO_PHP_34.pdf Accessed: October 9 2012
    Search in Google Scholar
  • 13 von Karsa L, Anttila A, Ronco G et al. Cancer screening in the European Union. Report on the implementation of the Council Recommendation on cancer screening – First report. Luxembourg: European Commission; 2008. Available at: http://ec.europa.eu/health/archive/ph_determinants/genetics/documents/cancer_screening.pdf Accessed: February 11 2012
    Search in Google Scholar
  • 14 Arbyn M, Anttila A, Jordan J et al., eds. European guidelines for quality assurance in cervical cancer screening. Second edition. Luxembourg: European Commission, Office for Official Publications of the European Communities; 2008
    Search in Google Scholar
  • 15 Perry N, Broeders M, de Wolf C et al., eds. European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition. Luxembourg: European Commission, Office for Official Publications of the European Communities; 2006
    Search in Google Scholar
  • 16 Malila N, Senore C, Armaroli P. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Organisation. Endoscopy 2012; 44 : SE31-SE48
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Moss S, Ancelle-Park R, Brenner H. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Evaluation and interpretation of screening outcomes. Endoscopy 2012; 44 : SE49-SE64
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Halloran SP, Launoy G, Zappa M. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Faecal occult blood testing. Endoscopy 2012; 44: SE65-SE87
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Valori R, Rey JF, Atkin WS et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Quality assurance in endoscopy in colorectal cancer screening and diagnosis. Endoscopy 2012; 44: SE88-SE105
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Steele RJ, Rey JF, Lambert R. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Professional requirements and training. Endoscopy 2012; 44: SE106-SE115
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Quirke P, Risio M, Lambert R et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Quality assurance in pathology in colorectal cancer screening and diagnosis. Endoscopy 2012; 44: SE116-SE130
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Steele RJ, Pox C, Kuipers EJ et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Management of lesions detected in colorectal cancer screening. Endoscopy 2012; 44: SE140-SE150
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Atkin WS, Valori R, Kuipers EJ et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Colonoscopic surveillance following adenoma removal. Endoscopy 2012; 44: SE151-SE163
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Austoker J, Giordano L, Hewitson P et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Communication. Endoscopy 2012; 44: SE164-SE185
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Vieth M, Quirke P, Lambert R et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Annotations of colorectal lesions. Endoscopy 2012; 44: SE131-SE139
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 von Karsa L, Patnick J, Segnan N. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Executive summary. Endoscopy 2012; 44: SE1-SE8
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 European guidelines for quality assurance in colorectal cancer screening and diagnosis – First edition. Segnan N, Patnick J, von Karsa L, et al. , eds. Luxembourg: European Commission, Publications Office of the European Union; 2010
    Search in Google Scholar
  • 28 Minozzi S, Armaroli P, Segnan N. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First edition – Principles of evidence assessment and methods for reaching recommendations. Endoscopy 2012; 44: SE9-SE14
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Minozzi S, Armaroli P, Segnan N. Principles of evidence assessment and methods for reaching recommendations. In: Segnan N, Patnick J, von Karsa L, , eds European guidelines for quality assurance in colorectal cancer screening and diagnosis – First edition. Luxembourg: European Commission, Office for Official Publications of the European Union; 2010: IL-LIX
    Search in Google Scholar
  • 30 Moher D, Cook DJ, Eastwood S et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 1999; 354: 1896-1900
    CrossrefPubMedSearch in Google Scholar
  • 31 Higgins JPT, Altman DG. Assessing risk of bias in included studies. In: Higgins JPT, Green S, , eds. Cochrane handbook for systematic reviews of interventions. UK: Wiley-Blackwell; 2008
    CrossrefSearch in Google Scholar
  • 32 EPOC. Cochrane Effective Practice and Organisation of Care Group (EPOC). Data 2002; Available at: http://www.epoc.cochrane.org/en/handsearchers.html Accessed October 9 2012
    PubMedSearch in Google Scholar
  • 33 Wells GA, Shea B, O’Connell D et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2010; Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm Accessed October 9 2012
    PubMedSearch in Google Scholar
  • 34 Whiting P, Rutjes AW, Reitsma JB et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003; 3: 25
    CrossrefPubMedSearch in Google Scholar
  • 35 Shiffman RN, Shekelle P, Overhage JM et al. Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization. Ann Intern Med 2003; 139: 493-498
    CrossrefPubMedSearch in Google Scholar
  • 36 SIGN. Scottish Intercollegiate Guidelines Network – Guidelines for the management of colorectal cancer. 2003 Available at: http://www.sign.ac.uk/pdf/sign67.pdf Accessed: February 11 2012
    PubMedSearch in Google Scholar
  • 37 NHS. Bowel Screening Programme Clinical Standards. Scotland: NHS Quality Improvement; 2007. Available at: http://www.bowelscreening.scot.nhs.uk/wp-content/uploads/2007/06/bowelsc_stnf_feb07.pdf Accessed: February 11 2012
    Search in Google Scholar
  • 38 Cotton PB, Williams CB. Colonoscopic polypectomy and therapeutic procedures. In: Cotton PB, Williams CB, , eds. Practical gastrointestinal endoscopy. 4th edn. Oxford: Blackwell Science; 1996: 275-302
    Search in Google Scholar
  • 39 Benson VS, Atkin WS, Green J et al. Toward standardizing and reporting colorectal cancer screening indicators on an international level: The International Colorectal Cancer Screening Network. Int J Cancer 2012; 130: 2961-2973
    CrossrefPubMedSearch in Google Scholar
  • 40 Zavoral M, Suchanek S, Zavada F et al. Colorectal cancer screening in Europe. World J Gastroenterol 2009; 15: 5907-5915
    CrossrefPubMedSearch in Google Scholar
  • 41 Arbyn M, Anttila A, Jordan J et al. European guidelines for quality assurance in cervical cancer screening. Second edition – Summary document. Ann Oncol 2010; 21: 448-458
    CrossrefPubMedSearch in Google Scholar
  • 42 Perry N, Broeders M, de Wolf C et al. European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition – Summary document. Ann Oncol 2008; 19: 614-622
    CrossrefPubMedSearch in Google Scholar
  • 43 von Karsa L. Mammographie Screening – umfassendes, populationsbezogenes Qualitätsmanagement ist hier gefragt!. [Mammography screening – comprehensive, population-based quality assurance is required!]. Z Allg Med 1995; 71: 1863-1867
    PubMedSearch in Google Scholar
  • 44 Donabedian A. The quality of care. How can it be assessed?. JAMA 1988; 260: 1743-1748
    CrossrefPubMedSearch in Google Scholar
  • 45 Winawer S, Classen M, Lambert R et al. World Gastroenterology Organisation/International Digestive Cancer Alliance guidelines: Colorectal cancer screening. Available at: 2007 http://www.worldgastroenterololgy.org/assets/downloads/en/pdf/guidelines/06_colorectal_cancer_screening.pdf Accessed: August 31 2012
    PubMedSearch in Google Scholar
  • 46 Lee BI, Hong SP, Kim SE et al. Korean guidelines for colorectal cancer screening and polyp detection. Clin Endosc 2012; 45: 25-43
    CrossrefPubMedSearch in Google Scholar
  • 47 Brink D, Barlow J, Bush K et al. Colorectal cancer screening. Available at: 2012 http://bit.ly/Colorectal0512 Accessed: August 24 2012
    PubMedSearch in Google Scholar
  • 48 Rex DK, Johnson DA, Anderson JC et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol 2009; 104: 739-750
    CrossrefPubMedSearch in Google Scholar
  • 49 Levin B, Lieberman DA, McFarland B et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008; 134: 1570-1595
    CrossrefPubMedSearch in Google Scholar
  • 50 Lieberman D, Nadel M, Smith RA et al. Standardized colonoscopy reporting and data system: report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. Gastrointest Endosc 2007; 65: 757-766
    CrossrefPubMedSearch in Google Scholar
  • 51 Sung JJ, Lau JY, Young GP et al. Asia Pacific consensus recommendations for colorectal cancer screening. Gut 2008; 57: 1166-1176
    CrossrefPubMedSearch in Google Scholar
  • 52 U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008; 149: 627-637
    CrossrefPubMedSearch in Google Scholar
  • 53 Rabeneck L, Rumble RB, Axler J et al. Cancer Care Ontario colonoscopy standards: standards and evidentiary base. Can J Gastroenterol 2007; 21 : 5D-24D
    PubMedSearch in Google Scholar
  • 54 Jover R, Herraiz M, Alarcon O et al. Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy 2012; 44: 444-451
    Thieme ConnectPubMedSearch in Google Scholar
  • 55 Schmiegel W, Pox C, Reinacher-Schick A et al. S3-Leitlinie “Kolorektales Karzinom” Ergebnisse evidenzbasierter Konsensuskonferenzen am 6/7. Februar 2004 und am 8./9. Juni 2007 (für die Themenkomplexe IV, VI und VII) S3-Guideline “Colorectal Cancer” 2004/2008. Z Gastroenterol 2008; 46: 1-73
    PubMedSearch in Google Scholar
  • 56 Cancer Care Ontario. Colorectal cancer screening. Surveillance guidelines. Available at: 2012 https://www.cancercare.on.ca/pcs/screening/coloscreening/cccstandardsguidelines/ Accessed: September 9 2012
    PubMedSearch in Google Scholar
  • 57 Rabeneck L, Zwaal C, Goodman JH et al. Cancer Care Ontario guaiac fecal occult blood test (FOBT) laboratory standards: evidentiary base and recommendations. Clin Biochem 2008; 41: 1289-1305
    CrossrefPubMedSearch in Google Scholar
  • 58 Soetikno RM, Kaltenbach T, Rouse RV et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 2008; 299: 1027-1035
    CrossrefPubMedSearch in Google Scholar
  • 59 Kudo S, Lambert R, Allen JI et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 2008; 68: 3-47
    PubMedSearch in Google Scholar
  • 60 Arain MA, Sawhney M, Sheikh S et al. CIMP status of interval colon cancers: another piece to the puzzle. Am J Gastroenterol 2010; 105: 1189-1195
    CrossrefPubMedSearch in Google Scholar
  • 61 Baxter NN, Goldwasser MA, Paszat LF et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med 2009; 150: 1-8
    CrossrefPubMedSearch in Google Scholar
  • 62 Brenner H, Hoffmeister M, Arndt V et al. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst 2010; 102: 89-95
    CrossrefPubMedSearch in Google Scholar
  • 63 Kahi CJ, Hewett DG, Norton DL et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol 2011; 9: 42-46
    CrossrefPubMedSearch in Google Scholar
  • 64 Kahi CJ, Li X, Eckert GJ et al. High colonoscopic prevalence of proximal colon serrated polyps in average-risk men and women. Gastrointest Endosc 2012; 75: 515-520
    CrossrefPubMedSearch in Google Scholar
  • 65 Steele RJ, McClements P, Watling C et al. Interval cancers in a FOBT-based colorectal cancer population screening programme: implications for stage, gender and tumour site. Gut 2012; 61: 576-581
    CrossrefPubMedSearch in Google Scholar
  • 66 Department of Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, University of Leeds. European Union Bowel Cancer Screening Pathology Examples. Available at: http://www.virtualpathology.leeds.ac.uk/eu/examples.php Accessed: 17 November 2012
    PubMed
  • 67 Winawer SJ, Zauber AG, Fletcher RH et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology 2006; 130: 1872-1885
    CrossrefPubMedSearch in Google Scholar
  • 68 Hill D, Dixon H. Prevention and Screening. Achieving behavioural changes in individuals and populations. In: Elwood JM, Sutcliffe SB, , eds Cancer Control. Oxford: Oxford University Press; 2010
    Search in Google Scholar
  • 69 Hanleybrown F, Kania J, Kramer M. Channeling change: making collective impact work. Stanford Social Innovation Review 2012; Available at: http://www.ssireview.org/blog/entry/channeling_change_making_collective_impact_work Accessed: October 10 2012
    PubMedSearch in Google Scholar
  • 70 Lynge E, Tornberg S, von Karsa L et al. Determinants of successful implementation of population-based cancer screening programmes. Eur J Cancer 2012; 48: 743-748
    CrossrefPubMedSearch in Google Scholar
  • 71 Martin-Moreno JM, Anttila A, von Karsa L et al. Cancer screening and health system resilience: keys to protecting and bolstering preventive services during a financial crisis. Eur J Cancer 2012; 48: 2212-2218
    CrossrefPubMedSearch in Google Scholar