Colorectal cancer screening in evolution: Japan and the USA

• Published in: Journal of gastroenterology and hepatology Vol. 25; no. s1; pp. S49 - S56
• Main Author: Ross, William A
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01-05-2010; Wiley-Blackwell
• Subjects: Biological and medical sciences; Canada - epidemiology; cancer screening; Colonography, Computed Tomographic - trends; colonoscopy; Colonoscopy - trends; colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - economics; Colorectal Neoplasms - epidemiology; Computer Simulation; Cost-Benefit Analysis; Digestive system. Abdomen; Endoscopy; Evidence-Based Medicine; Gastroenterology. Liver. Pancreas. Abdomen; Health Care Costs; Humans; Incidence; Investigative techniques, diagnostic techniques (general aspects); Japan - epidemiology; Mass Screening - economics; Mass Screening - trends; Medical sciences; Models, Economic; Practice Guidelines as Topic; Predictive Value of Tests; Quality Indicators, Health Care - trends; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Tumors; United States - epidemiology; Asia; United States; North America; Japan; America; Canada; Rectal disease; cancer screening; Colorectal cancer; Malignant tumor; Medical screening; Colonic disease; Colonoscopy; Gastroenterology; Digestive diseases; Intestinal disease; Evolution; Endoscopy; Cancer
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/j.1440-1746.2010.06221.x

Colorectal cancer (CRC) is one of the most common cancers in both Japan and the USA. Age‐adjusted incidence of CRC has been in decline in the USA since 1985, while rates in Japan have been increasing. The decline in the USA is commonly attributed to CRC screening programs but there is little direct evidence to support this assertion. The current screening recommendations in the USA cover several options including colonoscopy and computerized tomographic colonography (CTC). The Japanese CRC screening program is centered on fecal immunochemistry testing (FIT). The US government Medicare program's approval of colonoscopy as a primary screening test has lead to a large increase in the number of patients undergoing the procedure. However, the benefit achieved from this change in screening program emphasis is not clear. Simulation models demonstrate that a screening program centered on FIT achieves 94% of the benefit that an all‐colonoscopy program is able to accomplish but at a lower cost per life year gained. Clinical studies of colonoscopy have failed to demonstrate the 76–90% declines in CRC incidence predicted by the National Polyp Study published in 1993. A potential reason for this failure is the quality of colonoscopy performance. Until more compelling data becomes available demonstrating the utility of colonoscopy as a primary screening modality, there is little incentive to alter the proven cost‐effective approach to CRC screening currently in practice in Japan.