Article Text

Download PDFPDF
Original article
Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report
  1. Carlo Senore1,
  2. Partha Basu2,
  3. Ahti Anttila3,
  4. Antonio Ponti1,
  5. Mariano Tomatis1,
  6. Diama Bhadra Vale4,
  7. Gugliemo Ronco1,
  8. Isabelle Soerjomataram5,
  9. Maja Primic-Žakelj6,
  10. Emilia Riggi1,
  11. Joakim Dillner7,
  12. Miriam Klara Elfström8,
  13. Stefan Lönnberg9,
  14. Rengaswamy Sankaranarayanan10,
  15. Nereo Segnan1
  1. 1 SSD Epidemiologia e screening – CPO, University Hospital ‘Città della Salute e della Scienza’, Turin, Italy
  2. 2 Screening Group, International Agency for Research on Cancer, Lyon, France
  3. 3 Mass Screening Registry/Finnish Cancer Registry, Finnish Cancer Registry, Helsinki, Finland
  4. 4 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, Brazil, Campinas, Brazil
  5. 5 Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
  6. 6 Institute of Oncology Ljubljana, Ljubljana, Slovenia
  7. 7 Swedish Cervical Screening Registry, Stockholm, Sweden
  8. 8 Regionalt cancercentrum Stockholm-Gotland, Stockolm, Sweden
  9. 9 Cancer Registry of Norway, Oslo, Norway
  10. 10 Research Triangle Institute, International-India, New Delhi, India
  1. Correspondence to Dr Carlo Senore, SSD Epidemiologia e screening – CPO, University Hospital ‘Città della Salute e della Scienza’, Turin, 10123, Italy; carlo.senore{at}


Objective To present comparative data about the performance of colorectal cancer (CRC) screening programmes in the European Union Member States (EU MSs).

Design Cross-sectional study. We analysed key performance indicators—participation rate, positivity rate (PR), detection rate (DR) and positive predictive value for adenomas and CRC—based on the aggregated quantitative data collected for the second EU screening report. We derived crude and pooled (through a random effects model) estimates to describe and compare trends across different MSs/regions and screening protocols.

Results Participation rate was higher in countries adopting faecal immunochemical test (FIT) (range: 22.8%–71.3%) than in those using guaiac faecal occult blood test (gFOBT) (range 4.5%–66.6%), and it showed a positive correlation (ρ=0.842, p<0.001) with participation in breast cancer screening in the same areas. Screening performance showed a large variability. Compliance with referral for colonoscopy (total colonoscopy (TC)) assessment ranged between 64% and 92%; TC completion rate ranged between 92% and 99%. PR and DR of advanced adenomas and CRC were higher in FIT, as compared with gFOBT programmes, and independent of the protocol among men, older subjects and those performing their first screening.

Conclusions The variability in the results of quality indicators across population-based screening programmes highlights the importance of continuous monitoring, as well as the need to promote quality improvement efforts, as recommended in the EU guidelines. The implementation of monitoring systems, ensuring availability of data for the entire process, together with initiatives aimed to enhance reproducibility of histology and quality of endoscopy, represent a priority in screening programmes management.

  • colorectal cancer screening
  • colorectal adenomas
  • colorectal cancer
  • colonoscopy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Design of the survey CS, PB, AA, AP, MT, GR, RS and NS. Data collection: MT, DBV, AP and PB. Data analysis: CS, ER and MT. Drafting of the paper: CS, AP, SL and NS. Review of the analysis and of the content: all authors.

  • Funding European Union Public Health Programme (scientific and technical support to the European Partnership for Action against Cancer and follow-up of the implementation of the Council Recommendation on Cancer Screening).

  • Competing interests None declared.

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

  • Data sharing statement All data used for the analysis have been published in the EU screening report.

  • Correction notice This article has been corrected since it published Online First. Tables 3b and 4 have been amended.