Population Colorectal Cancer Screening in Asia: Insights From Established Programs

Colorectal cancer (CRC) is a major public health challenge, with Asia now the global epicenter. In response, population-based screening has become a cornerstone of CRC control in the region. This review provides a comprehensive analysis of the established national screening programs in Japan, South Korea, and Taiwan, comparing strategies, effectiveness, and quality assurance (QA) frameworks to identify key challenges and future directions.

We analyzed program governance, screening strategies, effectiveness data, QA frameworks, and cost-effectiveness, as well as emerging policies addressing issues such as young-onset CRC.

The population-based screening programs in all three countries primarily utilize the fecal immunochemical test (FIT) and have demonstrably reduced CRC mortality. While FIT remains the backbone of these programs, colonoscopy is being increasingly explored as a potential primary strategy in select contexts, but its capacity and manpower remain a concern for its use in population screening. QA is central to maintaining effectiveness. Cost-effectiveness analyses generally support both FIT-based and colonoscopy-based approaches, with risk-adapted strategies appearing to be the most efficient. Recent evidence highlights the importance of earlier initiation of screening in Asia, reflecting the rising incidence of young-onset CRC.

Population-based FIT-based screening is a highly effective public health strategy in East Asia. The future of CRC screening is a personalized paradigm, adapting policies such as lowering the screening age based on regional evidence and implementing risk stratification to build upon current successes and further mitigate the region's disease burden.