Screening for colorectal cancer - implications for general practice

Seifert Bohumil, Vojtíšková Jana, Herber Otto, Fric Premysl

Background
The epidemiology of colorectal cancer (CRC) is emerging both in morbidity and mortality. It is the leading cause of cancer death in Europe. On the other hand it is the most preventable visceral form of cancer. There are several strategies proven to be effective in secondary prevention of CRC.

Aims and Methods
Paper reviews current screening strategies for CRC from the primary care perspective, looks at the implementation of screening strategies in Europe and highlights some aspects of faecal occult blood testing (FOBT) based screening programs, using experience from the ongoing CRC screening program in the Czech Republic.

Results
The screening strategies for detecting cancer at an early curable stage include FOBT, flexible sigmoidoscopy, combined use of both these methods and colonoscopy. The guiac-based FOBT is the most extensively studied and used screening test. GPs are supposed to play a substantial role in CRC screening either assessing the risk of patients, explaining the screening options or deciding on the most individually appropriate method within the possibilities and organization of local health care system.

National screening programs have been introduced in several countries, such as Germany, Czech Republic, Slovakia and Poland. There were several important aspects of screening identified in the Czech experience, advisable to be a subject for monitoring in newly established programs. These aspects include target population adherence, eligibility of patients for screening, GPs´ involvement, FOBT positive rate and interdisciplinary cooperation.