Guidelines For Clinical Practice
Copyright ©2009 Baishideng. All rights reserved.
World J Gastrointest Endosc. Oct 15, 2009; 1(1): 12-16
Published online Oct 15, 2009. doi: 10.4253/wjge.v1.i1.12
Perspectives of colorectal cancer screening in Germany 2009
Andreas Sieg, Kilian Friedrich
Andreas Sieg, Kilian Friedrich, Practice of Gastroenterology and University of Heidelberg, Faculty of Medicine, D-69117 Heidelberg, Germany
Author contributions: Sieg A wrote the paper except the chapter on new developments, which was written by Friedrich K; Friedrich K helped with valuable discussion.
Correspondence to: Dr. Andreas Sieg, Professor, MD, Practice of Gastroenterology and University of Heidelberg, Bergheimer Str. 56 a, D-69117 Heidelberg, Germany.
Telephone: +49-6221-6599931 Fax: +49-6221-6599933
Received: March 10, 2009
Revised: March 26, 2009
Accepted: April 2, 2009
Published online: October 15, 2009

Adequate screening methods can decrease colorectal cancer (CRC) mortality. The guaiac test for fecal occult-blood (FOBT) is part of the German CRC Screening Program since 1970 and has evidence level Ia. In randomized multicenter-studies FOBT has an average sensitivity of 24% and decreases CRC mortality up to 30%. Immunological tests for human haemoglobin (iFOBT) show better performance characteristics than guaiac FOBT, with augmented sensitivity and specificity. However, the single tests show wide differences in diagnostic performance and iFOBT is not yet covered by insurance companies although it should replace the guaiac test for CRC screening. Visual colonoscopy, which was introduced to the German National Cancer Screening Program in 2002, is the gold standard for the diagnosis of colorectal neoplasia. From 2003 to 2007 more than 2.8 million examinations have been documented in Germany. The prevalence of adenomas is around 20% and of CRC about 0.7% to 1.0% of the screenings. Seventy percent of the carcinomas detected during screening are in an early stage (UICC I and II). Furthermore, screening colonoscopy is a cost saving procedure with a low complication rate (0.25% overall). Insurance companies save 216€ for each screening colonoscopy mainly by prevention of neoplasia due to polypectomy. In Germany, virtual colonography by computed tomography (CT) or magnetic resonance imaging still lacks standardization of the hard and software. In experienced centres the sensitivity for CRC and large polyps of CT colonography is comparable to colonoscopy but in meta-analyses the ranking is lower. New technologies like computer-aided colonoscopies with sheath or double balloon techniques are coming up as well as capsule colonoscopy, which sensitivity for large polyps is about 70%. Advised by his physician, the patient can choose his most acceptable examination method from this whole set of screening tools.

Keywords: Screening, colorectal cancer, Prevention, Colonoscopy, Virtual colonoscopy, Fecal occult blood test, Capsule colonoscopy