Implementing Colorectal Cancer Screening: Group 2 Report

Background

Colorectal cancer is an important cause of morbidity and mortality throughout the developed and the industrializing and westernizing countries of Europe [1]. It is now the most common cancer afflicting both sexes combined and the incidence is apparently rising in eastern European countries as lifestyle changes and reporting improves [2]. The high mortality in some of these countries reflects not only this rising incidence, but also the availability of diagnostic and treatment facilities. The causes include the ”Western” or industrialized lifestyle, innate genetic susceptibility, and the interaction between them.

The biological progress to clinical cancer is stepwise, over a period of time. This gives us a ”window of opportunity” to identify and treat the precancerous adenomatous polyp or early-stage cancer, before it becomes invasive and often beyond medical help. Good evidence now indicates that screening for colorectal neoplasia can decrease colorectal cancer incidence and mortality [3] [4]. Many countries are now considering population screening, or are carrying out pilot testing, or have organized programs of colorectal cancer screening [5]. Others have begun opportunistic screening [6].

Implementation of colorectal cancer screening on a broad scale requires a substantial amount of initial planning and resource allocation, including the definition of roles for different health professionals, identification of barriers to implementation, and provision of education, training, and tools to facilitate success. To do this in the diverse European countries requires knowledge of their medical systems, orientation towards cancer prevention, facilities for screening, and the populations concerned. Even though most European countries now have stable populations, there is some diversity within countries, associated with socioeconomic groups, ethnic or religious minorities, and immigrants. A different approach to implementation of colorectal cancer screening may be required for each of these groups.

The workgroup addressed the issue of implementing screening in the average-risk, asymptomatic population, and thus this report does not consider the population with a risk that is above average; that population requires identification, classification, and a particular specialized approach.

The workgroup consisted of 11 members from nine countries and included gastroenterologists, a nurse, a surgeon, and cancer advocates. This report is based on the one prepared in 2002 for the Union Internationale Contre le Cancer (UICC) along with additional input relevant to the European context [7]. For this, a questionnaire was sent to all participants, seven of whom replied. A summary was prepared of the specific issues that they identified within their countries, which, along with the subsequent discussion at the Workshop, forms this report.

References

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