Workgroup II: The screening process. UICC International Workshop on Facilitating Screening for Colorectal Cancer, Oslo, Norway (29 and 30 June 2002)

Abstract

The burden of colorectal cancer is high worldwide, and is increasing in many countries. It has the highest incidence of all digestive cancers worldwide, high mortality rates and a high cost to the community. Organized screening programs could significantly reduce mortality from colorectal cancer. Several highly effective screening strategies to achieve this goal are available today [1, 4, 5]. These screening strategies should be implemented within organized programs where possible in order to stimulate an increased awareness among the public and providers of the burden of the disease and the potential to reduce this burden through effective screening, diagnosis and treatment. When organized screening is not possible, opportunistic screening in the community should be encouraged within the framework of available resources and guidelines. In either instance, a large effort on the part of multidisciplinary groups including providers, public advocacy groups, the media and industry is required. In order to reduce the burden of colorectal cancer, numerous issues related to the choice of public health strategies need to be resolved. Is colorectal cancer screening better delivered in 'stand alone' settings or co-located in comprehensive centers with other cancer screening programs (e.g. Pap smear, mammography)? Can we develop an international terminology for describing the quality and effectiveness of screening programs? How do we maximize participation rates in the face of multiple colorectal cancer screening strategies, and different cultural orientations to the variety of testing strategies? What is the potential of emerging technologies? On a worldwide basis, the efforts and commitments of national and international organizations should be integrated with global initiatives already under way, such as those supported by the International Digestive Cancer Alliance. This Alliance was founded by the World Organization of Gastroenterology (OMGE), OMED, the United European Gastroenterology Federation (UEGF), European Society of Gastrointestinal Endoscopy (ESGE) and the Cancer Research and Prevention Foundation (CRPF). Recently its mission and campaign goals were outlined at a meeting at the Vatican in Rome, and a preliminary report of the meeting published in the OMGE/OMED newsletter. Finally, where screening is available, people aged over 50 years should be encouraged to act now, to discuss testing with their health-care provider and to be screened for colorectal cancer. The best test is the one that gets done, and any screening modality is better than none. The tendency for procrastination, i.e. to postpone action in anticipation of future, more promising technology that is more attractive, must be discouraged. In the world, approximately 2000 people will die every day from this disease. Strategies available today can cut this death toll in half. © 2005 European Society for Medical Oncology.