Vnitr Lek 2004, 50(Supplement 1):S103-S106

[The screening of sporadic colorectal cancer].

M Zavoral: 2. interní oddelení Ustrední vojenské nemocnice, Praha.

World Health Organization (WHO) defined the criteria for screening (i.e. the location of asymptomatic individuals) of the diseases seriously endangering the public health condition. The decisive criterion is the decrease of mortality with the disease the screening is made of. The programme based on the testing the asymptomatic individuals for the presence of the fecal occult bleeding (FOBT), which was introduced also in Czech republic, meets the criterion at the screening of colorectal cancer (CR-CA), which has been proved since the year 1993 by the two case-control studies and further particularly by the three prospective, randomized, controlled studies which independently proved the decrease of mortality for CR-CA in the screened population by 15-33%. This programme has been introduced in Federal Republic of Germany since 1977 as a part of free anticancer examination. In 1995 the programme was recommended by the commission of the independent specialists of US Department of Health and in 1998 by the commission of experts of the European Group for Colorectal Cancer Screening. In 2001 the commission of independent specialists of the US Department of Health analysed the contemporary preventive programmes in USA according to the importance of the disease monitored for the condition of public health and the effectiveness of the preventive programme. Based on these criteria there were defined 8 priority preventive programmes and as for the organ malignities there was only CR-CA screening filed there. All the screening programmes are based on the colonoscopic examinations in various time intervals, depending on familiar anamnesis, polyps size and their histologic structure. An alternative to the colonoscopy is a combination of flexible sigmoideoscopy and irigography, but this technique did not establish itself in a larger scale. On the contrary the developed countries offer--in the frame of the large studies as well as standardly--the screening colonoscopy as an alternative to the occult bleeding examination. The predictive ability of the less invasive imaging methods e.g. virtual CT colography is also assayed. The screening programme in the frame of Czech republic has been standardized and as a reccommendation available to the professional community since 2000.