IARC Handbooks of Cancer Prevention Volume 17: Colorectal cancer screening
A Working Group of 23 independent international experts met at the International Agency for Research on Cancer (IARC) on 14–21 November 2017 to evaluate the effectiveness of various colorectal cancer screening methods. A summary of the outcome of the meeting is published today as a Special Report in The New England Journal of Medicine. The detailed assessments will be published as Volume 17 of the IARC Handbooks of Cancer Prevention.
The IARC perspective on colorectal cancer screening
Lauby-Secretan B, Vilahur N, Bianchini F, Guha N, Straif K.
N Engl J Med. Published online 27 March 2018; http://dx.doi.org/10.1056/NEJMsr1714643
IARC Press Release 256: IARC Handbooks of Cancer Prevention Volume 17: Colorectal Cancer Screening English
Dr Béatrice Lauby-Secretan, who leads the IARC Handbooks of Cancer Prevention programme, discusses the evaluations of the Handbook on Colorectal Cancer Screening.
What is the aim of this Handbook, and how did you proceed?
The aim of this Handbook is to evaluate the effectiveness of the colorectal cancer screening procedures that are currently in place, in population-based programmes or in opportunistic settings.
There are two broad categories of colorectal cancer screening tests. The stool-based tests, such as the guaiac-based faecal occult blood test (gFOBT), or guaiac test, and the faecal immunochemical test (FIT), aim at detecting blood in stool. The endoscopic techniques, which include colonoscopy and sigmoidoscopy, allow a direct visualisation of the colon and rectum.
IARC convened an international group of experts to systematically review the available pertinent literature on the topic. The Working Group evaluated whether screening with a particular technique can reduce the risk of developing colorectal cancer, or of dying from the disease.
What are the most important outcomes of this review?
The most important conclusion is that for all of these techniques there is sufficient evidence that screening reduces the risk of death from colorectal cancer.
There are potential harms related to each technique: the psychological harms of screening in general, and physical harms related to the interventions in the case of endoscopic techniques. The Working Group reviewed the available evidence on such harms, and concluded that for all these techniques, the benefits of screening outweigh the harms.
What is new is this evaluation?
There are many studies on the effectiveness of colorectal cancer screening. This review has demonstrated, through a rigorous evidence-based approach, that screening for colorectal cancer has a beneficial impact in reducing the risk of developing the disease and of dying from it.
Why are these evaluations important?
Colorectal cancer is among the most common cancers in high-income countries, and its incidence is also increasing in low- and middle-income countries. However, colorectal cancer is preventable with very high effectiveness through the implementation of high-quality screening programmes.
This is a strong message to public health officials to improve currently existing population-based screening programmes, or to implement such a programme where none is in place.