Screening and Surveillance Colonoscopy

IntroductionColorectal cancer (CRC) is the second most frequent malignant disease in Europe.Every year, 412,000 people are diagnosed with this condition, and 207,000 patients die of it.Secondary prevention of CRC consists of early diagnosis of the disease in asymptomatic individuals (screening) and long term follow up of high risk patients (surveillance).Three groups of screening methods are currently available: stool testing (guaiac or immunochemical fecal occult blood tests -gFOBT and FIT respectively and DNA tests), endoscopic examinations (flexible sigmoidoscopy and colonoscopy) and radiologic examinations (computed tomographic colonography and double contrast barium enema).Colonoscopy is therefore used as the only screening method or as a second step in case of positive results of primary screening examination (two steps screening programs).From 27 countries in the European Union, the most frequently used test is FOBT (in 11 states).There is a choice between FOBT and colonoscopy in 6 countries.FOBT and flexible sigmoidoscopy is available in Italy.Currently, the only country using colonoscopy as the only screening method is Poland.At the end of 2010, the European guidelines for quality assurance in colorectal cancer screening and diagnosis were published, summarizing the evidence based medicine data for the efficacy, the interval, the age range, the risk-benefit and cost-effectiveness of colonoscopy screening.Unfortunately, prospective randomized trial on the effect of screening colonoscopy in the reduction of CRC incidence and mortality has not been published yet.Promising should be the NordICC study, which was introduced in 2009, however the results will be available in a fifteen year period.Series of recently published studies (Canada, Germany, Poland) focusing on the interval (post-colonoscopic) cancers confirmed the inadequate protection of proximal colon by colonoscopy.Another important issue would be the quality and safety of colonoscopy and the bowel cleansing.Concerning the surveillance colonoscopy, it plays a major role in specific follow up strategies in CRC high risk groups.It can be concluded that with some limitations, colonoscopy still remains the fundamental diagnostic and prophylactic examination in colorectal cancer screening and surveillance. Colorectal cancer epidemiology in EuropeColorectal cancer is the second most frequent malignant disease in developed countries.CRC incidence is generally higher in male population, and the risk of the disease increases www.intechopen.comEndoscopic Procedures in Colon and Rectum 2 with age, as the majority of cases are diagnosed in patients over 50 years of age (Spann et al., 2002).Burden of European countries is ranked as the highest in the global statistics, both in incidence and mortality.Compared to the US, in 1998 -2002 the European population showed a similar incidence for men, while that for women was slightly lower; the incidence in the USA for men and women was 38.6 and 28.3 respectively: in Europe it was 38.5 and 24.6 (ASR-W), as calculated per 100,000 inhabitants (Curado et al., 2007) .However, mortality over the same period of time was significantly higher in Europe than in the US, both for men and women: in the USA the figures were 13.5 and 9.2 respectively, while in Europe they were 18.5 and 10.7 (ASR-W), as calculated per 100,000 inhabitants (World Health Organization [WHO], 2006).To document the situation in Europe, we used figures available from the international studies summarizing global and European epidemiologic data (Curado et al., 2007;Ferlay et al., 2004Ferlay et al., , 2007;;Parkin et al., 2005).A detailed comparison of countries within Europe using the global age standardization (ASR-W) of incidence is presented in figure 1.

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