Overall, in all the European countries studied, 73% of the decrease in CRC mortality over ten years in males, and 82% in females, could be explained by their having had one or more endoscopic examination of the large bowel over the last ten years. "The evidence could not be clearer," Prof Autier says, "and it is therefore very disappointing that national differences in the availability of CRC screening programmes are still so pronounced."
The researchers believe that the large differences in screening rates between different European countries are due to a number of factors. "First, many countries still do not have a national CRC screening programme. Second, the acceptability of screening methods is often low, sometimes due to cultural differences between countries. There is also the question of the availability of qualified personnel. In some countries, there are insufficient gastroenterologists available to perform endoscopy. Even with FOBT screening, an endoscopy is needed if the test is positive," says Prof Autier.
Since the main goal of CRC screening is to remove polyps in the bowel, the risk of over-diagnosis is low, unlike that seen in breast and prostate cancer screening. "The risk of bowel perforation with endoscopy, while not non-existent, is very low and so far no trial has reported rates of perforation that could compromise the feasibility of screening on either practical or ethical grounds," Prof Autier says.
The researchers now intend to gather further data on screening and to include those from the USA, Canada, and Australia. "There are signs that CRC screening can reduce the incidence of this cancer as well as mortality from it,
|Contact: Mary Rice|
ECCO-the European CanCer Organisation