Population-Based Organized Service Screening for Colorectal Cancer

Abstract

This chapter first introduces the necessity of extending evidence-based colorectal cancer (CRC) screening illustrated with the stool-based screening methods into a service screening program. The concept and feature of opportunistic and organized service screening were then distinguished by the way of invitations to the targeted population eligible for screening, the infrastructure of information technology, timely follow-up, quality assurance, and the better tracking of clinical outcomes. We then provided a systematic review of the existing screening program with both structured opportunistic or population-based organized CRC screening across countries over the past 20 years. Detection modes of early and late detection of CRC as a result of the periodical population-based organized service screening are defined by attendance rate at each round of screen and cancer diagnosed between screen. Key elements for the implementation of population-based organized service screening are summarized. These include high attendance rate via mobilization of community construction, the installment of an integrated information system, the construction of an accessible referral system, the enrollment of sufficient manpower for outreaching screening and clinical service, the provision of sustained financial support, the integration of national or regional health care policy, the guidance of evidence-based information, the integration of primary care system and medical insurance system, and the development of evidence-based evaluation.

To achieve the most cost-effective in CRC screening, we prefer the organized service screening to opportunistic screening in order to systematically conduct, monitor, and evaluate a series process of periodical screening program from invitation, the uptake of screen, referral, confirmatory diagnosis, surveillance, and treatment until to the follow-up of primary and secondary outcomes.