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Contrasting US and European approaches to colorectal cancer screening: which is best?
  1. Geir Hoff1,
  2. Jason A Dominitz2
  1. 1Department of Medicine, Telemark Hospital, Skien, Norway
  2. 2VA Puget Sound Health Care System and Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Professor Geir Hoff, Department of Medicine, Telemark Hospital, NO-3710, Skien, Norway; hofg{at}


In the recent 1–2 decades, we have seen a considerable development in colorectal cancer (CRC) screening modalities and programme implementation, but major challenges remain. While CRC is still the second leading cause of cancer death in both the USA and Europe, there are limited data on the efficacy and effectiveness of all screening modalities except for the faecal occult blood test (FOBT). Newer screening tests, such as faecal immunochemical tests, molecular markers and CT colonography are being introduced and variably adopted, though overall rates of screening are suboptimal. Professional societies and governmental bodies have endorsed screening, though recommended approaches are quite variable, which may help to explain the great variation in screening practices. Unfortunately, quality assurance programmes are underutilised. Comparing the USA and Europe there may be more variation in CRC screening recommendation and practice within each continent than between them, but there seems to be a stronger emphasis on programmatic screening in Europe, facilitating quality assurance. The much debated need for randomised trials as new screening modalities emerge could be more easily handled if running screening programmes are regarded as natural platforms for testing out and evaluating presumed improvements in the service—including new emerging screening modalities.

  • Colorectal cancer screening
  • diverging strategies
  • Europe
  • USA

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  • Funding This material is based upon work supported by the VA Puget Sound Health Care System, Department of Veterans Affairs. JAD is supported by an American Society for Gastrointestinal Endoscopy Career Development Award. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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