Is there any role for prevention strategies for colorectal cancer other than population-based screening?

Colorectal carcinoma is a growing medical problem. Prevention represents the most effective approach for reducing the incidence and mortality. Population-based screening with subsequent colonoscopic polypectomy is the most common strategy. There are, however, other approaches increasing the portfolio of available measures. These include the special care of groups with an increased risk for CRC based on family or medical history and various chemopreventive strategies. Family history is a simple method to identify a person with increased risk of CRC. There are two groups of familial CRC: monogenetic hereditary syndromes such as FAP and HNPCC and hereditary predispositions with sporadic CRC. Recent advances in genetic tests and tailored surveillance strategies are able to decrease the morbidity and mortality in these groups. Therefore a wider recognition of family history as risk indicator of CRC should be encouraged. Chemoprevention is a very promising concept for both primary and secondary prevention of CRC. Although definite evidence is difficult to provide a number of studies suggest a role for nutritional interventions and/or chemoprevention with plant phytosterols, fiber, selenium, calcium, probiotics or COX2 inhibitors as putative chemopreventive strategies. (Tab. 4, Ref. 70.).