Risk-stratified colorectal cancer screening for optimal use of colonoscopy resources

摘要

Colorectal cancer (CRC) is the second most common malignancy and the third most common cause of cancer-related death in Korea, according to the national cancer statistics in 2016 [1]. The National CRC screening program of Korea was implemented in 2004, and it includes an annual fecal immunochemical test (FIT) for adults 50 years of age or older and subsequent colonoscopy for those positive for fecal occult blood [2]. Given that FIT cannot provide a confirmative diagnosis of CRC but can identify candidates for screening colonoscopy, the national CRC screening program is a risk-stratified screening model based on age and FIT results. In addition to Korea, other countries with CRC screening programs adopt FIT-based screening [3]. Biennial FIT-based screening showed a 10% reduction in CRC incidence and a 22% to 27% reduction in CRC-related mortality in Italy [4,5]. A similar biennial FIT screening program in Taiwan achieved a 62% reduction in CRC-related mortality in an observational cohort study [6].