Endoscopy 2007; 39(2): 168-173
DOI: 10.1055/s-2007-966182
Special article

© Georg Thieme Verlag KG Stuttgart · New York

Current status of screening colonoscopy in Europe and in the United States

C.  Pox1, 3 , W.  Schmiegel1, 3, 4 , M.  Classen2, 3, 4
  • 1Department of Internal Medicine, Ruhr-University Bochum, Bochum, Germany
  • 2Department of Internal Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
  • 3 German Society for Digestive and Metabolic Diseases
  • 4 International Digestive Cancer Alliance
Further Information

Publication History

Publication Date:
27 February 2007 (online)

Introduction

Colonoscopy screening for colorectal cancer and adenoma is already being practiced in the United States and in some European countries and it is being studied in others. In order to compare the experience gained to date and to discuss the existing evidence concerning endoscopic screening, a 1-day workshop entitled “Eurocolonoscopy” was held in Frankfurt am Main, Germany, on 10 May 2006. The workshop was organized by representatives of the European Society of Gastrointestinal Endoscopy (ESGE), the International Digestive Cancer Alliance (IDCA), the German Society of Digestive and Metabolic Diseases (DGVS), and the German Network against Colorectal Cancer, by participants from European countries where endoscopic screening is practiced, and by one representative from the United States. The workshop began with an overview of the screening conditions specific to each country, and this was followed by a general discussion about colonoscopy screening. This article summarizes the current status of colonoscopy screening in Europe and the United States.

Colorectal cancer (CRC) is now the commonest malignant tumor in Europe (excluding the Russian Federation) [1]. The overall 5-year survival rate is only around 50 % and the prognosis for advanced disease remains poor in spite of recent advances in treatment. The most important prognostic factor for CRC is disease stage at diagnosis [2]. To reduce CRC-related mortality, screening of asymptomatic population groups has been recommended [3] [4] [5] [6]. The aims of screening are to detect carcinomas at an early, asymptomatic stage and to reduce the incidence of CRC by detecting and removing adenomatous polyps, which are usually the precursor lesions of CRC.

There are several different screening methods available, including fecal occult blood testing (FOBT), flexible sigmoidoscopy, and colonoscopy. Most American screening guidelines recommend the use of either FOBT or endoscopic screening methods for the average-risk population [4]. In the European Union, the Advisory Committee on Cancer Prevention recommended FOBT as the primary screening method in 1999 [6]. This seems logical as large randomized trials have shown that screening with guaiac-based fecal occult blood testing (gFOBT) reduces CRC-related mortality [2] [7] [8] [9] and might also reduce the incidence of CRC [10]. In addition, there have been no randomized trials of the efficacy of colonoscopic screening. However, some experts consider colonoscopic screening methods to be more effective screening tools. This view is reflected in the guidelines from the American College of Gastroenterology and the German Society of Digestive and Metabolic Diseases (DGVS), which recommend colonoscopy as the preferred screening method [5] [11].

References

C. Pox, MD

Ruhr-Universität Bochum
Medizinische Klinik

Knappschaftskrankenhaus

In der Schornau 23 - 25

44892 Bochum

Germany

Fax: +49-234-299-3409

Email: Christian.P.Pox@ruhr-uni-bochum.de