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German colorectal cancer (CRC) screening via fecal occult blood testing (FOBT) is ineffective. Most eligible individuals aged 50-54 did not participate, indicating low adherence to CRC screening programs.

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Area of Science:

  • Oncology
  • Public Health
  • Preventive Medicine

Background:

  • Colorectal cancer (CRC) screening programs utilizing fecal occult blood testing (FOBT) can achieve high population coverage.
  • In Germany, FOBT screening was opportunistic until 2019, offered annually to individuals aged 50-54 and biannually to those 55+.
  • Previous analyses showed moderate adherence, but regular versus sporadic usage patterns remained unclear.

Purpose of the Study:

  • To analyze adherence trends in annual FOBT screening among individuals aged 50-54 in Germany.
  • To evaluate the effectiveness of the opportunistic screening model for CRC prevention.

Main Methods:

  • Utilized anonymized data from BARMER, a German statutory health insurance provider.
  • Examined adherence to annual FOBT screening from 2010-2022 for 945,214 individuals born between 1960-1968.
  • Focused on the 50-54 age group eligible for annual screening.

Main Results:

  • Only 22.5% of men and 55.1% of women underwent at least one FOBT between ages 50-54.
  • Annual screening adherence was very low: 0.1% for men and 1.8% for women.
  • Screening uptake has declined in recent years, with CRC detected in 1.4% of follow-up colonoscopies.

Conclusions:

  • The opportunistic FOBT screening approach for CRC in Germany is largely ineffective.
  • The majority of eligible individuals did not receive even a single screening test during the 50-54 age window.
  • Significant improvements in CRC screening participation are needed.