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Asia Pacific consensus recommendations for colorectal cancer screening
  1. J J Y Sung1,
  2. J Y W Lau1,
  3. G P Young2,
  4. Y Sano3,
  5. H M Chiu4,
  6. J S Byeon5,
  7. K G Yeoh6,
  8. K L Goh7,
  9. J Sollano8,
  10. R Rerknimitr9,
  11. T Matsuda10,
  12. K C Wu11,
  13. S Ng1,
  14. S Y Leung12,
  15. G Makharia13,
  16. V H Chong14,
  17. K Y Ho15,
  18. D Brooks16,
  19. D A Lieberman17,
  20. F K L Chan 1
  1. 1
    The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
  2. 2
    Department of Medicine, School of Medicine, Flinders University, Adelaide, Australia
  3. 3
    Sano Hospital, 2-5-1 Shimizugaoka, Tarumi-ku, Kobe, Hyogo, Japan
  4. 4
    Department of Internal Medicine, Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
  5. 5
    Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Songpa-gu Seoul, Korea
  6. 6
    Clinical Research Centre, National University of Singapore, Singapore
  7. 7
    Division of Gastroenterology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  8. 8
    Department of Medicine, University of Santo Tomas, Manila, Philippines
  9. 9
    Gastroenterology Unit, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  10. 10
    Division of Endoscopy, The National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
  11. 11
    Department of Gastroenterology, Xijing Hospital, Xi'an, Shaanxi, China
  12. 12
    Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
  13. 13
    Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
  14. 14
    Gastroenterology Unit, Department of Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Bandar Seri Begawan, Negara Brunei Darussalam
  15. 15
    Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  16. 16
    American Cancer Society, Dallas, Texas, USA
  17. 17
    Division of Gastroenterology, Oregon Health and Science University, Portland VA Medical Center, Portland, Oregon, USA
  1. Professor J Sung, Institute of Digestive Disease, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; joesung{at}


Colorectal cancer (CRC) is rapidly increasing in Asia, but screening guidelines are lacking. Through reviewing the literature and regional data, and using the modified Delphi process, the Asia Pacific Working Group on Colorectal Cancer and international experts launch consensus recommendations aiming to improve the awareness of healthcare providers of the changing epidemiology and screening tests available. The incidence, anatomical distribution and mortality of CRC among Asian populations are not different compared with Western countries. There is a trend of proximal migration of colonic polyps. Flat or depressed lesions are not uncommon. Screening for CRC should be started at the age of 50 years. Male gender, smoking, obesity and family history are risk factors for colorectal neoplasia. Faecal occult blood test (FOBT, guaiac-based and immunochemical tests), flexible sigmoidoscopy and colonoscopy are recommended for CRC screening. Double-contrast barium enema and CT colonography are not preferred. In resource-limited countries, FOBT is the first choice for CRC screening. Polyps 5–9 mm in diameter should be removed endoscopically and, following a negative colonoscopy, a repeat examination should be performed in 10 years. Screening for CRC should be a national health priority in most Asian countries. Studies on barriers to CRC screening, education for the public and engagement of primary care physicians should be undertaken. There is no consensus on whether nurses should be trained to perform endoscopic procedures for screening of colorectal neoplasia.

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