Report in English with a Dutch summary (KCE reports 45A)

KCE reports vol.45 Screening for Colorectal Cancer: Appendices 129
be screened only after the six-year implementation period. The effects of
screening will be evaluated, comparing the incidence of CRC and the mortality
from CRC in those invited to screening with controls. In that way the
implementation of colorectal cancer screening in Finland meets the criteria for a
randomized controlled trial and the requirements for a public health program.
This provided an opportunity to evaluate the program after five years and to
further adjust the screening strategy or to implement FOBT.
The screening program uses FOBT (unrehydrated Hemoccult II), a sample
collection procedure performed on three consecutive days. People in the target
group receive and return the tests by post. A Colorectal Screening Centre
based in the city of Tampere handles the distribution of FOBT s, interpretation
of results and contact with people tested. It provides advice and guidance for
people whose test results reveal the presence of blood in their stool samples to
ensure they undergo further testing arranged by their local health centre.
The tests are free of charge for the people being screened. The cost of
screening is estimated at 8 euro per invitation including the test and mail
charges, analysing the tests and providing the participants with written test
results and possible referrals for further examinations. In 2004, 4539 were
invited for screening; 75 % participated.
7.3.2 Groups at increased or high risk
Nation-wide preventative colonoscopic surveillance for mutation carriers in
HNPCC families has been organized since the early 80 s by the Finnish HNPCC
registry 528.
7.4 GERMANY
7.4.1 Average risk groups
In Germany there s no national screening program but different screening
options are being offered and paid by the statutory health insurance529, 530:
Annual FOBT test for individuals from 50 to 54 years old
Colonoscopy every 10 years from the age of 55 (since october
2002)
If the individual does not opt for a colonoscopy, the statutory health insurance
will refund FOBT every two years from the age of 55.
In 2003, 500.000 patients underwent colonoscopy screening 531.
All examinations are documented. A central institution collects the completed
data sheets, and an electronic version of the standardised colonoscopy protocol
is being prepared.