Studies on screening and surveillance for colorectal cancer

Colorectal cancer (CRC) is a major public health problem in the Western world. The life-time risk for developing CRC is approximately five percent and increases with age. In The Netherlands, the incidence of CRC is 67.5 per 100 000 in men and 46.7 per 100 000 in women (European Standardized Rate), resulting in about 12 000 new cases each year. In Europe, CRC is the third most common cancer diagnosed (after prostate and lung carcinoma) in men and the second most common cancer diagnosed (after breast cancer) in women. In total, it accounts for 13% of all cancer cases in Europe (in both men and women). Across the world, the incidence of CRC varies in different regions. The CRC incidence is highest in Western countries, including Northern and Western Europe, North America and Australia. Developing countries have lower rates, particularly Africa and Asia. These geographic differences appear to be attributable to environmental and dietary exposures, superimposed on genetically determined susceptibility. The incidence rates are gradually declining in North America due to CRC screening, remain stable in Northwest Europe, and increasing in East and Southern European countries due to lifestyle factors. In The Netherlands, each year, 4 500 deaths are CRC related. In Europe, CRC is the second most common cause of death from cancer after lung cancer. Five-year survival is 90% if the disease is diagnosed while still localized, 68% for a regional disease (i.e. disease with lymph node involvement), and only 10% if metastases are present. However, mortality rates are gradually declining in The Netherlands, which may be attributed to improvement of therapy, in particular adjuvant chemotherapy in colon carcinoma, and also improved staging, new surgical techniques, such as total mesorectal excision, and pre-operative radiotherapy for rectum tumours. Furthermore, the earlier stage detection of CRC improves the survival rate for CRC. Further improvement of survival can be expected from the introduction of population-based screening for CRC. Primary prevention of CRC can, theoretically, also be accomplished by improvement of life-style associated risk factors.

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