Early Detection of Colorectal Cancer and Population Screening Tests

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Colorectal cancer (CRC) is the most common newly-diagnosed cancer, one of the leading causes of illness and death in the Western world, and the second most common cause of cancer morbidity in Europe. Yet, CRC is a preventable disease and, if detected early, highly treatable. Early detection and prevention are health care strategies of critical importance for the reduction of CRC morbidity and mortality. In a number of countries, screening programmes have been implemented on nationwide scale since the 1960s for other forms of cancer. The early detection of cancer increases the likelihood of successful outcomes, but in order to have early detection, education and training promoting early diagnosis and resulting in increased screening, participation is needed. Additionally, the effectiveness of screening can be measured by the reduction on mortality, but it greatly depends upon tangible and sometimes intangible factors, contingent on setting and target population; it is essential, for example, to identify and screen the appropriate target population and to overcome implementation and uptake barriers. All of these issues, with emphasis on obstacles encountered at the level of general and family practice are highlighted in a recent editorial in Family Practice (Lionis and Petelos, 2011). Although the screening is performed in the context of public health, and for the benefit of the community, the rights and welfare of the individual should also be respected. The role of the General Practitioner/Family Practitioner (GP/FP) and generally of the Primary Care Provider (PCP) is challenging yet instrumental in achieving this balance, as it is at that level screening is initiated (Viguier et al, 2011). The involvement and the role of GPs and PCPs in convincing patients to participate and initiate CRC screening should be further explored and elucidated, as it is of key importance in cultural and organisational context and health policy issues (Sarfaty, 2006). CRC screening of asymptomatic population groups is currently recommended in the USA and many European countries, and a number of pilot and nationwide programmes have been developed for this purpose. More specifically, mass screening programmes are currently established in 13 of 39 European countries (Pox et al, 2007; Manfredi et al, 2011) with feasibility studies undertaken as pilot actions in many more.