Published online Apr 14, 2014. doi: 10.3748/wjg.v20.i14.3825
Revised: November 22, 2013
Accepted: January 6, 2014
Published online: April 14, 2014
Processing time: 197 Days and 18.3 Hours
Colorectal cancer (CRC) is the second most common cancer in Europe and its incidence is steadily increasing. This trend could be reversed through timely secondary prevention (screening). In the last twenty years, CRC screening programs across Europe have experienced considerable improvements (fecal occult blood testing; transition from opportunistic to population based program settings). The Czech Republic is a typical example of a country with a long history of nationwide CRC screening programs in the face of very high CRC incidence and mortality rates. Each year, approximately 8000 people are diagnosed with CRC and some 4000 die from this malignancy. Twenty years ago, the first pilot studies on CRC screening led to the introduction of the opportunistic Czech National Colorectal Cancer Screening Program in 2000. Originally, this program was based on the guaiac fecal occult blood test (FOBT) offered by general practitioners, followed by colonoscopy in cases of FOBT positivity. The program has continuously evolved, namely with the implementation of immunochemical FOBTs and screening colonoscopy, as well as the involvement of gynecologists. Since the establishment of the Czech CRC Screening Registry in 2006, 2405850 FOBTs have been performed and 104565 preventive colonoscopies recorded within the screening program. The overall program expanded to cover 25.0% of the target population by 2011. However, stagnation in the annual number of performed FOBTs lately has led to switching to the option of a population-based program with personal invitation, which is currently being prepared.
Core tip: The rising incidence rate of colorectal cancer (CRC) puts demands on systematic approaches towards secondary prevention. The National CRC Screening Program in the Czech Republic has been running for more than 13 years. Nowadays, guaiac and immunochemical fecal occult blood tests (FOBT) are used, as well as screening colonoscopy. The quality control system was devised with the introduction of CRC Screening Registry. Since 2006, 104565 preventive colonoscopies have been performed: 89752 FOBT+ colonoscopies (85.8%) and 14813 screening colonoscopies (14.2%). Adenomas were diagnosed in 30515 patients undergoing FOBT+ colonoscopy (34.0%), and in 3719 patients through screening colonoscopy (25.1%). In all preventive colonoscopies, a total of 4193 cancers were registered.