Screening of colorectal cancer state of the art and implementation in France

Colorectal cancer is a major health problem in industrialised countries. Colorectal cancer fulfils the conditions required for mass screening. Considerable research efforts have been launched over the last 15 years to evaluate screening tests ability to decrease colorectal cancer incidence and mortality. Data from case-control studies and randomised studies indicate that it is possible to reduce colorectal cancer mortality in people who accept screening with fecal occult blood testing. Population-based studies rely on biennial Hemoccult test in subjects between 50 and 74 and total colonoscopy in cases of positive test. In order to decrease significantly colorectal cancer mortality compliance has to be between 50 and 65 % in the first screening campaign and to remain high in the succeeding ones. The time has come to implement well-organised population-based fecal occult blood screenings despite current limitations of available tests. Efforts should be continued to improve fecal occult blood tests. They must be evaluated at a population level before being proposed in organised screening programmes.