Colorectal cancer screening: 14-years experience in Germany

Since 2002, a colonoscopy performed every ten years has been an integral part of the colorectal cancer screening program in Germany offered to all member of statutory health insurance at the age of 55, and covering a population of approximately 16.7 million people. In addition, the screening program includes standardized patient information, performed on 2,240,000 people/year, and fecal guaiac fecal occult blood test (fGOBT), performed in 4,051,000 people annually. Approximately 395,000 screening colonoscopies were performed annually, and data from more than 1750 participating centers were centrally collected and analyzed. However, only 2 - 2.5% of the entitled members annually participated in colonoscopy. The relative rate of colonoscopy was correlated with the social status. Females participated more often than males. Therefore, from 2003 to 2012, 4,403,030 colonoscopies were performed, with simultaneous polypectomy in 31.8% of the examinations. More than 290,000 advanced adenomas were resected. Colorectal cancer was diagnosed in 42,000 patients, predominantly at a low tumor stage (UICC stage I-II: 69%). The overall complication rate of screening colonoscopy was low, with severe complications (bleeding or perforation) in approximately 0.05 - 0.2%. A Markov Model estimation revealed 180,000 prevented cases of colorectal carcinoma (1/28 of screening colonoscopies), 40,000 carcinomas detected earlier than they would have been diagnosed without screening (1/121 screening colonoscopies), and 4500 cases of over-diagnosis (1/1089 screening colonoscopies). Epidemiological data reveals a decrease in incidence and mortality due to colorectal cancer from 1999 to 2012. In the future, the next steps will be the establishment of a more individualized screening program according to certain populations at risk for colorectal carcinoma.