[Colorectal carcinoma: screening--early detection]

Colorectal cancer is the second leading cancer disease in Germany. The mortality is still 60%. 75% of the patients have no risk factors for colorectal cancer, 18% have a positive family history for the disease. In these patients colorectal cancer arise from benign adenomatous polyps. A 76-90% reduction in colorectal cancer incidence can be achieved by endoscopic polypectomy. Tumor stage is an important determinant of outcome. In Dukes stage A the overall survival rate is over 90%. By annual fecal occult blood test the incidence and mortality rate of colorectal cancer can be reduced significantly. The combination of fecal occult blood test and flexible sigmoidoscopy seems to be more effective. An alternative strategy is a colonoscopy every ten years. But the important problem in Germany is the very low compliance of the patients. Only 16% of the men and 34% of the women are participating in cancer surveillance program.