Pitfalls and Opportunities in Colorectal Cancer Screening

Colorectal cancer (CRC) is the third most common cancer and the second leading cause of death from cancer in the Western world. Screening has been shown to reduce CRC incidence and mortality. The first evidence that colorectal cancer screening could effectively reduce mortality dates back 20 years. Despite this fact, population screening has long been halted at the level of individual testing and discussions of the differences between screening tests. With a wealth of new evidence from various community-based studies looking at test uptake, screening-program organization and the importance of quality assurance, population screening for CRC has come of age. That is, opportunistic individual testing is now shifting towards organized population screening with comprehensive monitoring and full-program quality assurance. Health councils encourage and support member states to implement CRC screening with an organized population-based approach and appropriate quality assurance at all levels. In this process, the focus turns from the test alone to the combination of a range of factors including the target population, test characteristics, uptake, screenee autonomy, capacity, diagnosis and management of the disease, and costs. This thesis aims to explore methods to improve and optimize population screening for CRC.

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