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

KCE reports vol.45 Screening for Colorectal Cancer 55
Key messages
All guidelines recommend that CRC screening should be offered to
average (low) risk patients 50 year and otherwise asymptomatic.
All guidelines recommend that colonoscopy should be used for the
follow-up of test positive subjects.
Guidelines disagree on optimal ages of screening ( 50, 50 - 70, 50 -
75, 50 - 80) and on which test and which modalities to choose.
Screening benefits include reduction in colorectal cancer mortality,
possible reduction in cancer incidence through detection and
removal of colorectal adenomas and potentially less invasive
therapy due to early treatment of colorectal cancers.
If FOBT is chosen as primary mass screening test, unrehydrated
home-administered FOBT is univocally recommended, requiring the
patient to collect and submit 3 stool test cards, each card with 2
separate stool samples from each of 3 consecutive bowel
movements.
Single office-based FOBT obtained at the time of a digital rectal
examination is disapproved.
There is no justification for repeating FOBT after an initial positive
finding.
In many countries experts and public health decision makers are
reluctant to set up a systematic national population screening
program because of low sensitivity of the common guaiac screening
test Hemoccult II added to observed moderate compliance rates,
even with participation enhancement strategies.
All guidelines recommend total colonoscopy as the first choice
screening method for population subgroups at increased CRC risk
as well as for surveillance.
Guidelines are not concordant on risk stratification, cut-off ages and
screening or surveillance frequency, nor on evidence rating scales.
Screening recommendations for populations subgroups at
increased risk are empiric and combine the known effectiveness of
available screening tools with the observed risks associated with a
positive family history of CRC.