Conflicts between Clinical and Public Health Viewpoints: Colorectal Screening

Abstract

In Hungary, the mortality rates from colorectal cancer are dramatically high, therefore the reduction by population screening as a public health measure is considered as one of the priorities of the National Public Health Programme. The aim of screening is to reduce the burden of cancer on the population by discovering latent disease in its early stage and treating it more effectively than if diagnosed later in a symptomatic stage. In the beginning, a human-specific immunological test was applied in the "model programmes", as a screening tool to detect the occult blood in the stool; compliance was 32% in average. However, the objectives of the model programmes have not been achieved, because-among other reasons-a debate on method of choice and the strategy to follow have divided the professional public opinion. In this paper the debated issues are critically discussed, being convinced that-at present-population screening seems to be the most promising way to alleviate the burden of colorectal cancer. In 2002, the government of Hungary, in the frame of the National Public Health Programme, took aim "to develop an organized colorectal screening programme based on detection of humanspecific faecal occult blood, and in this way, to reduce the colorectal cancer mortality by 20% by the year 2010" [5]. This objective has been approved by the Parliament [6]. In 2008, the National Audit Office declared that "the aim of reducing colorectal mortality by screening has not been realised" [7]. The reason for the non-achievement had generated a heated debate on the strategy and methodology of colorectal screening