Screenee perception and health-related quality of life in colorectal cancer screening: a review

The incidence of colorectal cancer (CRC) has increased sharply in the Western world from 1970 (1). A steady increase of environmental risk factors for CRC (obesity, smoking, low physical activity, poor diet) has called for CRC prevention not only in Western Countries, but recently also in Asia (2). This has resulted in an appeal from the European Commission to its member states to establish CRC screening programmes nation-wide. At present, this recommendation has been followed to varying degrees: with a particular eagerness of some East-European countries in which the level of CRC incidence was particularly high (3), but with hesitation and slowness in some others West-European countries with a similar incidence (1). FOBT has traditionally been the most common test used in CRC screening, but in later years sigmoidoscopy or colonoscopy have become increasingly popular. In the US and in Germany, colonoscopy is strongly promoted as first-line screening method, whereas a pre-screening with FOBT and sigmoidoscopy is recommended in others, such as the United Kingdom. Differences in screening recommendations are motivated to some extent by organisational and economic reasons, but also by the scarcely documented public presumption that the more invasive endoscopic procedure might create negative perceptions and impair the Health-related Quality of Life (HRQoL) of potential screenees. Frequently the medical community shares this worry and tends to favour less burdensome (but also less sensitive) imaging procedures for CRC screening such as CT-colonography. Non-evidence-based opinions can survive for long periods, not only in general but also in professional communities and, can potentially inhibit beneficial medical developments