Colorectal cancer (CRC) screening is a rapidly moving field. This thesis provides strategies and insights that may contribute to optimizing CRC screening. The main topics of the thesis are introduced in part I which gives an overview of the burden of CRC worldwide and the initiatives to reduce this burden. Part II further focusses on fecal occult blood test-based CRC screening. The main two fecal occult blood tests are the guaiac-based fecal occult blood test (gFOBT) and the more recently developed fecal immunochemical test (FIT). The diagnostic accuracy of FIT and gFOBT in average-risk individuals is compared in a meta-analysis. The subsequent chapters explore various aspects of FIT screening and optimization of FIT screening strategies. We focus on age differences, cut-off, the use of two FITS per screening round instead of one, and the predictive value of a negative FIT in subsequent screening rounds. Part III of the thesis provides more insight in factors that are associated with quality in CRC screening, surveillance and colonoscopy. The accuracy, quality, and readability of online information on CRC screening and surveillance is evaluated. Also, quality indicators for colonoscopy are obtained from different hospitals and the effect of plenary feedback on variation in quality of colonoscopy is assessed. Furthermore, adherence to recommended surveillance intervals following removal of adenomas is evaluated. Finally, part IV discusses the main findings and insights obtained from our research projects and gives directions for future research.

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E.J. Kuipers (Ernst) , M.C.W. Spaander (Manon)
Erasmus University Rotterdam
The printing of this thesis has been financially supported by the Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam; Nederlandse Vereniging voor Gastroenterologie; Bevolkingsonderzoek Zuid-West; Chipsoft B.V.; CorporateHealth International; DaklaPack Clinical Trials B.V.; Eiken Chemical Europe; Erbe Nederland B.V.; Ferring B.V.; Norgine B.V.; Olympus Nederland B.V.; Pentax Medical B.V.; Tramedico B.V.; Zambon Nederland B.V.
Erasmus MC: University Medical Center Rotterdam

Schreuders, E. (2016, December 15). Optimizing Colorectal Cancer Screening. Retrieved from