Prevention and early detection of colorectal cancer in average risk population - Summary of a meeeting and the israeli gastroenterology policy

Background: Colorectal cancer (CRC) is a leading cause of cancer mortality, with a lifetime risk of 5-6% and mortality rate of nearly 50%. About 75% of the cases occur in average-risk individuals. CRC ideally fulfils the criteria for organizing a massscreening program: It is common and lethal, cancer is preceded by a pre-malignant lesion (adenoma) and transition from precursor to malignancy develops over years, providing an opportunity for intervention. It is well established that removal of adenomas (polypectomy) prevents CRC and CRC-related death in up to 90% of the cases. In Israel, we lack a clear policy for CRC screening and prevention by the health authorities. A meeting on this subject was held at the Israel Cancer Association, attended by the Minister of Health and leading figures in gastroenterology, oncology and public health. Aims: To summarize the meeting and the Israeli Gastroenterology Association policy. Summary: Current data on fecal occult blood test, sigmoidoscopy, and colonoscopy was presented, including the reduction of cancer incidence and mortality, safety and cost-effectiveness of each modality. Worldwide and Israeli results on colonoscopy in average-risk persons age 50-75, demonstrated a considerable prevalence of neoplasia, a low morbidity rate, no mortality and a high cost-effectiveness. Based on these results and the literature evidence of up to 90% reduction of CRC mortality following colonoscopy, CRC justifies all the criteria for organizing a prevention program by the health authorities for average-risk population age 50-75. Screening colonoscopy for CRC prevention should be included in this program.