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  • Review Article
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Colorectal cancer screening—optimizing current strategies and new directions

Abstract

The first evidence that screening for colorectal cancer (CRC) could effectively reduce mortality dates back 20 years. However, actual population screening has, in many countries, halted at the level of individual testing and discussions on differences between screening tests. With a wealth of new evidence from various community-based studies looking at test uptake, screening-programme organization and the importance of quality assurance, population screening for CRC is now moving into a new realm, promising better results in terms of reducing CRC-specific morbidity and mortality. Such a shift in the paradigm requires a change from opportunistic, individual testing towards organized population screening with comprehensive monitoring and full-programme quality assurance. To achieve this, a combination of factors—including test characteristics, uptake, screenee autonomy, costs and capacity—must be considered. Thus, evidence from randomized trials comparing different tests must be supplemented by studies of acceptance and uptake to obtain the full picture of the effectiveness (in terms of morbidity, mortality and cost) the different strategies have. In this Review, we discuss a range of screening modalities and describe the factors to be considered to achieve a truly effective population CRC screening programme.

Key Points

  • Screening is a very cost-effective method for reducing colorectal cancer (CRC) incidence and mortality and includes noninvasive faecal occult blood tests and faecal immunochemical tests as well as sigmoidoscopy and colonoscopy

  • Opportunistic, individual testing is now shifting towards organized population screening with monitoring and full-programme quality assurance

  • As such, the focus shifts from the test alone to factors across the screening programme in combination, including test characteristics, uptake, screenee autonomy, cost, endoscopy performance and long-term follow-up

  • Targeting each of these factors will increase population coverage, improve overall quality and decrease quality variation, which will improve the preventive effect of screening and markedly reduce CRC incidence and mortality

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Figure 1
Figure 2: Cost performance modelling of GFOBT and FIT screening using the MISCAN model.89
Figure 3: Organization of the information system in the Dutch nationwide population-screening programme based on biennial FIT screening.

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E. J. Kuipers researched the data for the article and wrote the manuscript. All authors edited the manuscript before submission.

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Correspondence to Ernst J. Kuipers.

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Kuipers, E., Rösch, T. & Bretthauer, M. Colorectal cancer screening—optimizing current strategies and new directions. Nat Rev Clin Oncol 10, 130–142 (2013). https://doi.org/10.1038/nrclinonc.2013.12

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