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Colorectal Cancer: Incidence and Mortality Rates | Screening Activities

Inventory of Colorectal Cancer Screening Activities in ICSN Countries, June 2006

Please note: This is not the most recent compilation of these data. Refer to the May 2008 table for more recent information.

Country Respondent / Web Site Description of CRC Screening Activity

Cheryl Wilson
Director, Bowel Cancer Screening Section
Targeted Prevention Programs Branch
Canberra, ACT, Australia Web Site Policy

Following the successful pilot program that ran from 2002-2004, the Australian government has allocated funding to phase in a National Bowel Cancer Screening Program, using an immunochemical FOBT, followed by colonoscopy if indicated. The first phase of the program (2006-2008) will target people turning 55 or 65 years of age between 1 May 2006 and 30 June 2008 and those who participated in the Pilot Program. FOBT kits will be sent by direct mail; those with a positive test will be advised to see their doctor. A national register is being established to issue invitations to screening and follow people up to the point of diagnosis. This phase-in of the Program will be evaluated in 2008; if found to be successful on clinical grounds, it will be expanded to those aged 55-74 years.

Christina Bancej
Manager, Screening and Early Detection
Public Health Agency of Canada

National recommendations for the development of population-based CRC screening programs have been developed. No Canadian province or territory has yet implemented a program, although Ontario has initiated a pilot and Quebec is planning one. Additional pilot projects will be implemented in the near future through grants supported by the Canada Institutes for Health Institute of Cancer Research.

Elsebeth Lynge Web Site Policy

One RCT of CRCS was undertaken in Denmark. A pilot project targeting people aged 50-74 is ongoing in 2 counties. Its purpose is to test participation and the stage distribution of detected cases. No other service screening is occurring at this time.

Nea Malila
Director of the Mass Screening Registry
Cancer Society of Finland Web Site Policy

Phased implementation of a national screening program over a 10-year period with guaiac-based FOBT was launched in 2004. Individuals aged 60-69 comprise the target population (n = 500,000). Colonoscopy is being used for follow-up of positive tests.

Hélène Sancho-Garnier
Rosemary Ancelle-Park Web Site Policy

The national program comprises 23 pilot projects which are using un-rehydrated biennial FOBT. Follow-up assessment is with colonoscopy. Target population is 50-74 age group; mailed invitations with 2 recalls of nonresponders; last recall includes the test. The pilots are being conducted in the same districts with organized mammography screening, which has national coverage. National coverage of colorectal cancer screening was scheduled for late 2006, but political difficulties have delayed the programme.

Dominik Dietz Web Site Policy

Screening colonoscopy was introduced 2002 in addition to FOBT. Individuals ages 50-54 use yearly FOBT. For those ages 55+, there is a choice, either 2 colonoscopies (second colonoscopy minimum 10 years after the first) or biennial FOBT. An information sheet, which explains the potential benefits and harms of both screening methods, is given to patients. It is an opportunistic screening program.

Kristjan Sigurdsson
Medical Director
Icelandic Cancer Detection Clinic

The Director of Health has recommended implementing a population-based screening program using biennial FOBT in individuals aged 55-70, with colonoscopy as follow up. Program would be centralized at the Icelandic Cancer Detection Clinic. Pending approval of the Ministry of Health.

Gad Rennert

Organized program covering a target population of 700,000 individuals ages 50-74 in the country’s largest health care provider is in place. The country’s other three, smaller health providers have been instructed to implement a comparable program. The government has established national oversight of provider activities and quality. Program uses annual sensitive FOBT (Hemoccult Sensa) followed by colonoscopy for evaluation of positive cases. Israel has a national policy on CRC screening in average-risk and high-risk populations.

Marco Zappa
Carlo Senore Web Site Policy

A national recommendation of the Minister of Health has set for each region the goal of achieving at least 50% coverage of the target population with a CRC screening programme by the end of 2007. To date, screening programmes offering biennial I-FOBT are ongoing in Lombardia, Basilicata, Emilia-Romagna, Tuscany, Lazio, and Veneto (8 out of 10 programmes). In Piedmont and in two programmes in Veneto, sigmoidoscopy (FS) is offered to individuals aged 58-60. People older than 59 (or 60) who did not respond to FS are offered I-FOBT as an alternative.

Noriaki Ohuchi
Hiroshi Saito *

A national CRC screening program using annual I-FOBT has been in place since 1992. The program is conducted through local governments and targets 35 million individuals aged 40+ who are national insurance holders.

Won Chul Lee Web Site Policy

A national screening program that includes breast, cervical, colon, stomach, and liver cancer is in place. Colorectal cancer screening has been part of the program since 2004. Annual FOBT (I-FOBT or Hemoquant) is offered to individuals aged 50+. Double contrast barium enema and/or colonoscopy are used for follow-up of positive FOBTs. The total target population is 3.5 million, and the screening rate is about 14%. The screening program is free of charge.

Astrid Scharpantgen

Ministry of Health has developed a promotional campaign to prompt patient-physician discussions about CRCS with FOBT or endoscopy. Particular emphasis on identifying high risk individuals. No plans to set up an organized national screening program at this time.

Jacques Fracheboud
Iris Vogelaar *
Department of Public Health
Erasmus MC

No population-based CRC screening program in the Netherlands at this time. However, the Minister of Health is considering implementation in the next 2-3 years. In 2006, a pilot study assessing compliance and organizational issues in an FOBT-based program began in 2 areas of the Netherlands. This pilot is evaluating 2 different types of FOBT. In another area of the Netherlands, a trial comparing FOBT and sigmoidoscopy will begin in late 2006.
New Zealand

Brian Cox

At present, New Zealand has no organized programs for CRC screening. There is some opportunistic screening using FOBT and/or sigmoidoscopy in high-risk groups.

Geir Hoff

The screening phase of an RCT of once-only flexible sigmoidoscopy alone compared with FS + I-FOBT was finalized in 2001 (NORCCAP-1) An RCT on colonscopy screening is being planned (NORCCAP-2).

Vitor Rodrigues

National Oncologic Plan identifies CRC screening as a major goal for Portugal. No organized screening program has been implemented yet because of disagreement about the role of screening colonoscopy. Opportunistic screening with colonoscopy is taking place in some hospitals.

Nieves Ascunce

Assessing the feasibility of a national screening program using FOBT has been recommended in Spain’s national cancer plan. At present, two regional pilot studies have been implemented. The majority of hospitals offer screening with colonoscopy to high-risk individuals.

Sven Tornberg

To date there are no organized CRC screening programs in Sweden, with the exception of small-scale continuation of the Gothenburg study (with low participation). The Swedish Board of Health and Welfare has not yet issued guidelines for CRC screening. Several counties are collaborating in the development of a CRC screening protocol but have not implemented organized screening.

Jean-Luc Bulliard

A small, prospective study is underway to compare the acceptability of, compliance with, and preference for 3 screening methods (FOBT, FOBT + sigmoidoscopy, colonoscopy) in individuals aged 50-80 in 3 Swiss regions. Opportunistic screening with colonoscopy is common in Switzerland among individuals over the age of 50.
United Kingdom

Julietta Patnick Web Site Policy

A multi-center trial of one-time flexible sigmoidoscopy in individuals aged 55-64 is in progress. In addition, a programme of biennial guaiac-based FOBT in individuals aged 60-69 will begin in England in 2006 and for those 50–74 in 2007 in Scotland.
United States

Carrie Klabunde

Screening with FOBT, sigmoidoscopy, colonoscopy, and double-contrast barium enema is being promoted through guideline dissemination and media campaigns. No organized national program, although a demonstration pilot project targeting low-income, uninsured individuals has been implemented in 5 sites. Some organized programs operate through health plans and local health departments. A multi-center trial of sigmoidoscopy is in progress, as is a trial in 5 sites that compares screening colonoscopy with annual Hemoccult Sensa.

Gonzalo Pou
Dr. Carlos Sarroca
Dra. Adriana Della Valle Web Site Policy

Study underway to promote screening and healthy behaviors in general and higher cancer risk populations (HCRP). We focused on the latter group, examining the molecular basis and clinical behavior of 12,400 individuals recruited from 307 families. Methods of prevention, early detection, treatment, and follow-up are presented to the HCRP. Currently, the overall survival of this controlled group is superior to that of the general population.

* Denotes the primary contact on colorectal cancer screening activities for this country.

1 Information not updated since spring 2004.

Information not available for the following ICSN countries: Belgium, Greece, Hungary, Ireland.