International Journal of Technology Assessment in Health Care


Policies of screening for colorectal cancer in European countries

Iñaki Gutiérrez-Ibarluzeaa1, José Asuaa2 and Kepa Latorrea3

a1 Osteba-Basque Office for HTA and Nursing University School Vitoria-Gasteiz

a2 Osteba-Basque Office for HTA

a3 Hospital Txagorritxu, Osakidetza-SVS


Objectives: The aim of this study was to analyze the current status of population screening for colon/rectum cancer in Europe to compare the different strategies, the coverage, the existence of pilot experiences, regional coverages, and the risk factors considered in each strategy.

Methods: A comprehensive, systematic search was performed in the literature for documents addressing population screening for colon/rectum cancer in Europe. An ad hoc questionnaire was prepared including questions considered relevant. The questionnaire was reviewed by experts in the area. To identify key informants, colleague members of the International Network of Agencies for Health Technology Assessment (INAHTA), participants in the EUnetHTA project, or representatives of the ministries of health of the different European countries were contacted. The information provided by key informants was checked with information directly obtained from the ministries of health, gray literature, and research documents.

Results: An 88 percent response rate was obtained. In countries for which no questionnaire data were collected, information was directly retrieved from the Web sites of the corresponding ministries. Four countries were found to perform population screenings: Austria, France, Germany, and the United Kingdom. However, they used different strategies. Five countries had begun regional or local strategies: Denmark, Finland, Italy, Spain, and Switzerland, and two additional countries (the Netherlands and Norway) reported ongoing research studies intended to determine the best strategy to implement a population-based screening program. Differences were found in age range, procedure chosen, and follow-up period.

Conclusions: Even though the European Council recommended a wider implementation of population screening for colon/rectum cancer, our results suggest that this recommendation continues to be valid. The differences found in screening strategies (in terms of age range, procedures, risk factors considered, and follow-up periods) are not warranted by the results obtained in research studies or regional-national cancer registries.


The authors thank the invaluable comments by Dr. Alberto Infante and the information provided by the following people: Alric Ruether (Germany); Claudia Wild (Austria); Kare Hansen and Birgitte Bonnevie (Denmark); Minna Kaila (Finland); Sun Hae Lee Robin (France); Davide Mauri (Greece); Wim van Veen, Kees Groeneveld, and Wim Goetsch (the Netherlands); Colm O'Morain (Ireland); Elena Berti and Teresa Gasparetto (Italy); Inger Norderhaug, Hans Peter Aarseth, and Michael Bretthauer (Norway); Cristina Bastos (Portugal); Rune Sjödahl (Sweden); Felix Gurtner and Chris Kuenzli (Switzerland); and Claire Packer (United Kingdom). The authors state that they have no conflicts of interest. This study was partly funded by the Quality Agency for the National Health System of the Spanish Ministry of Health and Consumer Affairs.