Colorectal cancer screening

The organised colorectal cancer screening programme in the general population of Finland was launched in 2004 among 22 volunteering municipalities out of 444 in total. An experimental design was incorporated in public health evaluation using randomisation at individual level in the target population (men and women aged 60-69 years).   
The programme expands gradually over regions and age-cohorts during the first six years. The primary screening test is a biannual guaiac-based faecal occult blood test with three test cards for consecutive samples. Test positives, i.e. any blood detected in any test window in one or more of the cards, will be referred for full colonoscopy.  
Altogether 190 municipalities have joined the programme between 2004 and 2008. The programme covered approximately 40% of the target population by end of 2008. During this period, 48,926 men and 49,897 women aged 60-68 years were invited for screening and the control group is of the same size (48,906 men and 49,700 women).  
Attendance to screening by end of 2007 has been good, 71% overall, 63% in men and 78% in women. Among the screened, 2.1% were found with blood in the stools, 3% of men and 1.5% of women. Cancers were detected according to expectations, in around 9% among those who underwent colonoscopy.   
The implementation of screening measured with attendance and performance of the test has been successful. The programme meets the criteria for a public health programme using a scientifically valid comparison group with individually randomised controls.

Municipalities by year of starting the screening