Initial Impact of National CRC Screening on Incidence and Advanced Colorectal Cancer

Myrtle F. Krul*, Marloes A.G. Elferink, Niels F.M. Kok, Evelien Dekker, Iris Lansdorp-Vogelaar, Gerrit A. Meijer, Iris D. Nagtegaal, Emilie C.H. Breekveldt, Theo J.M. Ruers, Monique E. van Leerdam, Koert F.D. Kuhlmann

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)


Background and Aims: Screening for colorectal cancer (CRC) aims to decrease CRC incidence and mortality. Biennial fecal immunochemical test screening started in the Netherlands in 2014 for individuals 55–75 years of age. This study investigated the effect of screening on stage-specific incidence, with focus on stage III and IV CRC. Methods: Inhabitants diagnosed with CRC in 2009–2018 were included. CRC incidence per stage, year, and detection method (ie, screen-detected vs clinically detected) was evaluated. Patient, tumor, and treatment characteristics, and survival of patients with stage III and IV CRC, were compared according to the detection method. Results: Included were 140,649 CRCs in 136,882 patients. An initial peak of stage I–III CRC diagnoses after initiation of screening was followed by a continuous decrease within screening-eligible ages. Total CRC incidence remained higher than before screening, although stage II and IV CRC incidence decreased below prescreening levels. Screen-detected CRCs were significantly more frequently located in the left-sided colon (stage III; 43.7% vs 30.9%; stage IV: 45.1% vs 36.1%), and the primary tumor resection rate was higher (stage III colon: 99.8% vs 99.0%, rectum: 97.3% vs 89.7%; stage IV colon: 65.4% vs 56.6%, rectum: 47.3% vs 33.5%). Patients with screen-detected stage IV CRC had significantly more often single-organ metastases (74.5% vs 57.0%; P < .001) and more frequently received treatment with curative intent (colon: 41.3% vs 27.4%; rectum: 33.8% vs 24.6%). Overall survival significantly improved for patients with screen-detected CRCs (stage III: P < .001; stage IV: P < .001). Conclusions: Five years after the start of a nationwide CRC screening program, a decrease in stage II and IV CRC incidence was observed. Patients with screen-detected stage III and stage IV CRC had less extensive disease and improved survival compared with those with clinically detected CRC.

Original languageEnglish
Pages (from-to)797-807.e3
JournalClinical Gastroenterology and Hepatology
Issue number3
Early online date16 Sept 2022
Publication statusPublished - Mar 2023

Bibliographical note

Funding Information:
The authors thank the registration teams of the Netherlands Cancer Registry and Nationwide Network and Registry of Histopathology and Cytopathology in the Netherlands for the collection of data. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Publisher Copyright:
© 2023 AGA Institute


Dive into the research topics of 'Initial Impact of National CRC Screening on Incidence and Advanced Colorectal Cancer'. Together they form a unique fingerprint.

Cite this