Conference executive summary

CRC screening & knowledge base

  1. Colorectal cancer (CRC) is the most common newly diagnosed cancer and the second most common cause of cancer death in Europe. More than 430,000 European citizens are diagnosed and over 210,000 Europeans die each year from malignant tumours of colon and rectum (1).
  2. Based on the results of numerous randomized controlled trials, mortality from colorectal cancer can be effectively reduced through early cancer detection by the faecal occult blood test (2).
  3. High-quality screening programme is able to translate the outlined efficacy into a real-life effectiveness, i.e., to prevent cancers (3), to save lives (4) and to save an enormous amount of financial resources (5).

CRC screening & State of the Art

  1. In Europe, CRC screening is recognized and recommended as an important healthcare programme (6, 7).
  2. Many European countries have already implemented CRC screening programmes in recent years (8).
  3. To maintain a favourable balance between benefits and harms when dealing with large populations, it is necessary to apply comprehensive quality standards and best practice in the implementation of cancer screening programmes. For that purpose, professional European guidelines for quality assurance in CRC screening have been recently published and recommended by the European Commission (9).
  4. Standard, most common diagnostic methods for CRC screening involve: FOBT followed by colonoscopy in case of positive findings and/or primary screening colonoscopy (9).
  5. Gold standard of the screening model is well-defined and recommended (9), consisting in a population-based national screening programme. However, where this model is not applicable, opportunistic screening is recommended as a functional alternative and/or a primary step, as a nationwide programme or as an initiative for limited, closed communities.

CRC screening & Current Challenges

  1. The heterogeneity is still significant between European countries, both in design and in the content of CRC screening programmes. More intensive communication, feedback analyses of reached results and a platform to exchange experience between countries should be supported and facilitated.
  2. Modern CRC screening needs an innovative, up-to-date, comprehensive and effective information policy: a pan-European policy. Methodical effort which will further develop already published guidelines in the field of communication and information policy is highly demanded. The guidelines focused on information policy might help European governments and stakeholders to motivate target groups to participate in cancer prevention, to set up communication priorities and to link all kinds of cancer prevention in a logical model.
  3. Legislative background of nationwide healthcare programmes such as CRC screening should be more harmonized throughout Europe, namely in two fields: 1) to cover functional and reachable models for addressed invitation of participants to the programme, 2) to allow information services and merge of required data sources within an adequate legislative framework.
  4. CRC screening promotion should be more visibly enriched by an exact economic dimension. Cost-effectiveness modelling and quantification of economic benefits of the CRC screening should be supported, among others also as a part of European grant policy. Translational research approaches, international collaboration and cross-boundary networking are needed.
  5. Europe needs a dedicated Centre for Cancer Prevention, unifying the diverse national, professional and scientific activities involved.


1. Ferlay J, Shin HR, Bray F, et al. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available from:, accessed on 17/05/2012.
2. Hewitson P, Glasziou P, Watson E, et al. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol 2008;103:1541–9.
3. Brenner H, Hoffmeister M, Brenner G, et al. Expected reduction of colorectal cancer incidence within 8 years after introduction of the German screening colonoscopy programme: estimates based on 1,875,708 screening colonoscopies. Eur J Cancer 2009;45:2027–33.
4. Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012;366:687–96.
5. Sieg A, Brenner H. Cost-saving analysis of screening colonoscopy in Germany. Z Gastroenterol 2007;45:945–51.
6. The Council of the European Union (2003/878/EC). Council Recommendation of 2 December 2003 on cancer screening. Official Journal of the European Union, Vol. 16, p. 34–39. ISSN 1725-2555
7. Poc P, Brepoels F, Busoi CC, Leinen J, Peterle A. Written declaration on fi ghting colorectal cancer in the European Union. The European Parliament, PE449.546v01-00. 20. 12. 2010.
8. Karsa L, Anttila A, Ronco G, et al. Cancer Screening in the European Union: Report on the implementation of the Council Recommendation on cancer screening. Luxembourg: European Communities 2008.
9. Segnan N, Patnick J, von Karsa L, editors. European guidelines for quality assurance in colorectal cancer screening and diagnosis. Luxembourg: Publications Office of the European Union; 2010.