Contrasting US and European approaches to colorectal cancer screening: which is best?

• Published in: Gut Vol. 59; no. 3; pp. 407 - 414
• Main Authors: Hoff, Geir, Dominitz, Jason A
• Format: Journal Article Book Review
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.03.2010; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Biological and medical sciences; Colorectal cancer; Colorectal cancer screening; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - prevention & control; Costs; Deoxyribonucleic acid; diverging strategies; DNA; Europe; Evidence-Based Medicine - methods; Gastroenterology. Liver. Pancreas. Abdomen; Genetic testing; Health care policy; Humans; Mass Screening - methods; Mass Screening - organization & administration; Medical sciences; Medical screening; Mortality; Program Evaluation; Quality control; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Task forces; Tumors; United States; USA; United States; Europe; Colonic disease; Rectal disease; Colorectal cancer; Gastroenterology; Digestive diseases; Intestinal disease; Surgical approach; Malignant tumor; Medical screening; European; Cancer
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gut.2009.192948

In the recent 1–2 decades, we have seen a considerable development in colorectal cancer (CRC) screening modalities and programme implementation, but major challenges remain. While CRC is still the second leading cause of cancer death in both the USA and Europe, there are limited data on the efficacy and effectiveness of all screening modalities except for the faecal occult blood test (FOBT). Newer screening tests, such as faecal immunochemical tests, molecular markers and CT colonography are being introduced and variably adopted, though overall rates of screening are suboptimal. Professional societies and governmental bodies have endorsed screening, though recommended approaches are quite variable, which may help to explain the great variation in screening practices. Unfortunately, quality assurance programmes are underutilised. Comparing the USA and Europe there may be more variation in CRC screening recommendation and practice within each continent than between them, but there seems to be a stronger emphasis on programmatic screening in Europe, facilitating quality assurance. The much debated need for randomised trials as new screening modalities emerge could be more easily handled if running screening programmes are regarded as natural platforms for testing out and evaluating presumed improvements in the service—including new emerging screening modalities.