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Colorectal Cancer: Incidence and Mortality Rates | Screening Activities

Inventory of Colorectal Cancer Screening Activities in ICSN Countries, May 2008

Country Respondent Description of CRC Screening Activity
Australia Marissa Otuszewski
Marissa.otuszewski@Health.gov.au Director, Bowel Cancer Screening Section
Targeted Prevention Programs Branch
Canberra, ACT, Australia
Following the successful pilot program that ran from 2002-2004, a National Bowel Cancer Screening Program which uses immunochemical FOBT, followed by colonoscopy if indicated, will be introduced. 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. iFOBT kits will be sent by direct mail; individuals with a positive test will be advised to see their doctor. A national register is being established to issue invitations to screening and to follow people up to the point of diagnosis. This phase-in of the Program will be evaluated in 2008; if successful on clinical grounds, it may be expanded to a wider age cohort.
Belgium Pr. Andre-Robert Grivegnee
Brussels Regional Screening Centre
Institut Jules Bordet
Brussels, Belgium

In Brussels, there is a hospital-based program that has been running since 1994 (50-74 years, men and women; about 10,000 patients enrolled and screened by sigmoidoscopy/colonoscopy every 5 years).

In the French community, a regional organized program will be deployed by 2009. It will target men and women aged 50-74 years and use biennial FOBT.

Canada Jay Onysko
Jay_Onysko@phac-aspc.gc.ca Manager, Screening and Early Detection
Public Health Agency of Canada
National recommendations for the development of population-based CRC screening were published in 2002. Since then a number of Provinces have implemented small-scale pilot screening program projects. In 2007, Provinces and Territories began to formally announce their intentions to launch organized CRC screening programs and/or indicate CRC screening as an upcoming priority. Programs are presently at various stages of development, with some provinces still at the planning phase and others moving to expand their existing pilots. At the Federal level, a Pan-Canadian CRC Screening Network has been established to promote collaborative action aimed at facilitating the development of CRC screening programs across Canada.
Denmark Elsebeth Lynge
One RCT of CRC screening was undertaken in Denmark. A pilot project of FOBT targeting people aged 50-74 was undertaken in 2 counties. Its purpose was to test participation, and the stage distribution of detected cases. Participation was about 50%. The potential benefits of CRC screening have been reviewed by a new committee. At this time, there is no service screening occurring in Denmark.
Finland Nea Malila
Director of the Mass Screening Registry
Cancer Society of Finland
The Finnish population screening programme for CRC has had two screening rounds. It started in 22 of the country’s municipalities in September 2004. By the second round, in 2006, it had expanded to include over 160 of the country’s 400 municipalities. The programme uses individual level randomization, where half of the target population is offered screening now, and half will stay as controls for the first six years. The programme will continue to grow in the coming years both in terms of national coverage and the range of age cohorts offered screening. Presently, the programme targets women and men aged 60-69. It uses guaiac-based FOBT, a sample collection procedure performed on three consecutive days by people at home. People in the target group receive and return the tests by mail. Nearly 53,000 people were offered screening during 2004-2006; 71% complied. Overall, women’s participation rate was 78% while the rate among men was 63%. Compliance was also influenced by age and marital status. The oldest cohort—people born in 1940—had a higher participation rate. 81% of married women and 69% of married men completed screening. The lowest rate of participation was among single men, of whom just 46% took part. So far the screening programme has found 62 cases of CRC. This is out of the 804 individuals whose test results detected blood in faecal samples, and who subsequently received colonoscopies.
France Rosemary Ancelle-Park
At the end 2007, the national program comprised 80 districts, 56 of which were in the initial training phase. The test used is un-rehydrated guaiac biennial FOBT. Follow-up assessment is with colonoscopy. Target population is 50-74 age group; mailed invitations with 2 recalls of nonresponders; second recall includes the test. The pilots are being conducted in the same districts as those with organized mammography screening, which has national coverage. National coverage (99 districts) of colorectal cancer screening is scheduled for late 2008.
Germany Dominik Dietz
Screening colonoscopy was introduced in 2002 in addition to FOBT. Individuals ages 50-54 use yearly FOBT. For those aged 55+, there is a choice, either 2 colonoscopies (second colonoscopy minimum 10 years after the first; every screening colonoscopy performed after age 65 counts as a second colonoscopy) 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. A number of quality standards and quality assurance measures are used to monitor screening colonoscopy.
Hungary Dr. Imre Boncz
University of Pecs
Department of Health Economics, Policy & Management
An immunochemical technique—developed in Hungary—that is suitable for simultaneous analysis of two blood proteins—haemoglobin and albumin—in the faecal sample has been used in 2 CRC screening pilot projects. One project was conducted in an administrative region of Budapest, Hungary, in 1997–98 with support from the World Bank Close the gap public health program, and the other in Ajka, Hungary and its surrounding area in 2003–04. The sample size was 6513 participants in the World Bank project and 3996 in the Ajka project covering the population aged between 45-65 years. The pilot projects are completed, and currently (2008) the establishment of a nationwide organized screening program is under discussion.
Iceland 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. The program would be centralized at the Icelandic Cancer Detection Clinic. Pending formal approval of the Ministry of Health.
Israel Gad Rennert
There is a national policy and organized program established by the Ministry of Health. The policy is to screen on an annual basis all individuals aged 50-74 with Hemoccult Sensa; colonoscopy is used for evaluation of positive cases. High-risk individuals (1st degree family history of CRC) are eligible for screening colonoscopy every 2-3 years. The program has been implemented by all 4 health providers (not-for-profit HMOs) that cover the entire target population for this activity (about 1.1 million people). The national program oversees the performance of all providers.
Italy Nereo Segnan*
Marco Zappa
Carlo Senore
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. In 2006, 69 screening programmes were active in 11/21 Italian regions) (target population of 6,240,000 among 14,000,000 Italians 50-69 years old). 2,106,000 people have been invited to biennial I- FOBT; 907,000 were screened (45%). In 2005, the detection rate was 0.37 % for cancer and 1.68% for advanced adenomas at first screening (recall rate 5%) , 0.11 and 0.49 respectively at subsequent screening episodes (recall rate 4.1%). In 5 programmes in Piedmont and in two programmes in Veneto, once only sigmoidoscopy (FS) was offered to 50,000 individuals aged 58-60; 7,600 complied (15%). People older than 59 who did not respond to FS are offered I-FOBT as an alternative.
Japan Noriaki Ohuchi
Hiroshi Saito*
A national CRC screening program using annual I-FOBT was implemented in 1992. The program is conducted through local governments and targets 35 million individuals aged 40+ who are national insurance holders. National CRC screening guidelines were revised in 2005 to recommend FOBT or I-FOBT for organized screening, although I-FOBT is stated as being the preferred test. Increasing the participation rate (18%) is an important goal.
Won Chul Lee
A national screening program that includes breast, cervical, colon, stomach, and liver cancer is in place. CRC screening has been part of the program since 2004. Annual FOBT (I-FOBT or Hemoquant) is offered to individuals aged 50+. DCBE and/or colonoscopy are used for follow-up of positive FOBTs. The total target population is 4.4 million, and the screening rate was about 16% in 2006. The screening program is free of charge.
Luxembourg Astrid Scharpantgen
The Ministry of Health has developed a promotional campaign to prompt patient-physician discussions about CRC screening with FOBT or colonoscopy. Particular emphasis on identifying high risk individuals. Opportunistic screening with colonoscopy is common among individuals over the age of 50. There are plans to set up an organized national screening program with colonoscopy by the year 2009.
Malaysia Dr Nor Hayati Othman
Dean, Clinical Science Research & Professor of Pathology,
Universiti Sains Malaysia,
Kubang Kerian, Kelantan, Malaysia hayati@kb.usm.my
At present, Malaysia does not have an organized national CRC screening program. However, many people know that they could go to any private and public hospitals for screening [FOBT]. The National Cancer Registry in 2003 recorded Age Standardized Rate for colon cancer as 10.1 and rectal cancer as 7.8 per 100,000 populations. When the 2 cancers are combined CRC is the most common cancer in men and the third most common cancer in women. Our recent study showed that mean age of CRC seen in our hospital was 56.92 -/+ SD 15.35. The male to female ratio was 1.86:1.0. 85.0% of them had metabolic diseases; 13% Diabetes Mellitus Type 2(DM2),34.8% hypertension (HPT) and 13.8% had ischemic heart disease (IHD). Statistically, the metabolic diseases were associated with the stage of cancer; DM2;p<0.043, HPT and IHD;p<0.001. The association of metabolic diseases with CRC is recently established. Two projects, “Genome-wide Analysis of the Allelic Imbalance in Sporadic CRC patients in Malaysia” and “Identification of Proteomic Biomarker for CRC”, are currently underway in 2007-2008.
Netherlands Iris Vogelaar
Department of Public Health
Erasmus MC
There is no population-based CRC screening program in the Netherlands at this time. Results from a pilot study assessing compliance and organizational issues in an FOBT-based program in 2 areas of the Netherlands are expected in spring 2008. This pilot has evaluated 2 different types of FOBT. In another area of the Netherlands, a trial comparing 2 types of FOBT and sigmoidoscopy is being conducted. Results are expected in 2008. Based on the outcomes of these three pilot studies, the Minister of Health is expected to decide on the implementation of a population-based CRC screening program.
New Zealand Brian Cox
Susan Parry
Diana Sarfati
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. (2014 update: please see the New Zealand Ministry of Health's bowel screening pilot pageExternal Web Site Policy.)
Norway 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).
Portugal Vitor Rodrigues
Both the National Oncologic Plan and National Health Plan identify CRC screening as a major goal for Portugal. No organized program has been implemented yet but one is scheduled to begin in the central region in 2008. This new organized program will use FOBT as the primary screening test. Opportunistic screening with colonoscopy is taking place in some hospitals.
Spain Nieves Ascunce
Assessing the feasibility of a national screening program using FOBT has been recommended in Spain’s national cancer plan. At present, three regional pilot studies have been implemented. The majority of hospitals offer screening with colonoscopy to high-risk individuals.
Sweden Sven Tornberg
Population based service screening for CRC was introduced in Stockholm county in January 2008. This is the first county in Sweden to initiate a CRC service screening program. The program uses FOBT and targets the age group 60-69, men and women, at two years interval. The entire population is included (no exclusion). A centrally organised call and recall system is used. Test kits are sent to participants at their home address. A reminder is sent after 4 weeks if non- attendance. Participants are notified of negative test results by mail. Participants with positive test results are referred for colonoscopy. There is centralised monitoring of the program, which is operated in close cooperation with the Finnish (Nea Malila) and UK (Julietta Patnick) programmes.
Switzerland Jean-Luc Bulliard
An on-going, prospective study targeting about 2,500 rural Swiss residents aged 50 to 80 years indicates that participants prefer screening with colonoscopy to FOBT alone or FOBT + sigmoidoscopy, and that international quality standards for CRC screening are met. Implementation of a larger, pilot, population-based CRC screening programme is being discussed. Future Swiss health surveys will include items to enable better monitoring of CRC screening uptake in the population. Opportunistic screening with colonoscopy is common in Switzerland among individuals over the age of 50.
United Kingdom Julietta Patnick
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 began in England in 2006 and for those 50–74 in 2007 in Scotland. The whole of England will be screening by the end of 2009 and expansion up to age 75 will commence from 2010. Wales will begin screening some people aged 50-74 in 2009.
United States Carrie Klabunde
Screening with FOBT, sigmoidoscopy, colonoscopy, and double-contrast barium enema (DCBE) 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. A multi-center trial comparing the performance of CT colonography/virtual colonoscopy to optical colonoscopy was recently completed.

Gonzalo Pou
Dr. Carlos Sarroca
Dra. Adriana Della Valle

Web page:
www.dnsffaa.gub.uy/GCUExternal Web Site Policy

Study underway to promote screening and healthy behaviors in general and higher cancer risk populations (HCRP). The program establishes CRC risk and investigates the molecular basis for CRC to improve the accuracy of treatment and follow-up. 14,000 individuals have been recruited from 340 families. HCRP individuals receive annual colonoscopy and treatment (extended colon resections; prophylactic hysterectomy; anexectomy) as needed.

Since 2005, a National Policy for CRC Detection has been in place. The policy promotes annual screening for asymptomatic individuals aged 50-70 by iFOBT with follow-up of positive cases by colonoscopy.

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

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

View the June 2006 compilation of these data.

Last Updated: 21 Mar 2018