FUTURE PERSPECTIVES ON UTILIZATION OF COLONOSCOPY IN COLORECTAL CANCER SCREENING IN JAPAN

Abstract

For further improvement of colorectal cancer (CRC) screening in Japan, consideration should be given to more efficient use of colonoscopy in population-based screening. The effectiveness and safety of screening colonoscopy should be clarified first. Regarding its effectiveness, reduced CRC mortality with sigmoidoscopy has been proven in several randomized controlled trials (RCTs), whereas several RCTs on total colonoscopy are currently ongoing. In addition, the cost-effectiveness of and nationwide capacity for performing colonoscopy screening should be evaluated. Model analysis has been used to assess the cost-effectiveness of and nationwide capacity for performing colonoscopies in CRC screening in several foreign countries. Our recent study applying model analysis for the assessment of CRC screening in Japan indicates that the use of screening colonoscopy could help improve both the effectiveness and cost-effectiveness of screening. Introduction of screening colonoscopy presents a potentially strong option in Japan. Despite this promise, the large number of requisite colonoscopies may pose a problem. Further investigation, including evaluation of the capacity to perform screening colonoscopies, is necessary for assessing the appropriateness of screening colonoscopy in Japan.