[What is confirmed in colorectal cancer screening?]

The incidence and mortality of colorectal cancer in Germany has declined in recent years. Nevertheless, colorectal cancer is still the second most common cancer in women (after breast cancer) and the third most common in men in Germany (after prostate cancer and lung cancer). Screening for colorectal cancer is well-established in many countries. The two most recommended screening strategies are colonoscopy and fecal immunochemical testing (FIT, stool test for occult blood).

This article explains important conceptual and practical differences between the two strategies offered in Germany and summarizes the latest high-quality evidence for the benefits of the most frequently used screening tests. The aim is to provide physicians with decision aids for patients who show interest in colorectal cancer screening.

Confirmed high-quality evidence from randomized trials on the benefits of screening for colorectal cancer with respect to incidence and mortality.

The lifetime risk to develop colorectal cancer in Germany is 5% for women and 6.5% for men. According to a large randomized trial, a screening colonoscopy reduces the risk of colorectal cancer from 1.2% to 0.8-0.9% after 10 years. New high-quality evidence from a recent Spanish randomized trial also showed that the benefits of FIT screening every other year are comparable to those of 1 colonoscopy over 10 years. The risks of perforation and bleeding during colonoscopy are 0.01% and 0.1%, respectively.

During the medical patient clarification on screening, it is recommended that the abovenamed facts on benefits and risks should be included and explained.