2025 Volume 63 Issue 3 Pages 357-364
In Japan, annual colorectal cancer screening using a two-day fecal immunochemical test (FIT) has been implemented since 1992, and an age-adjusted mortality rate reduction has been observed since around 1996. In contrast, colorectal cancer screening primarily relies on colonoscopy in the United States, while other countries predominantly utilize FIT. The other major Group of Seven (G7) countries and South Korea have achieved greater reductions in mortality rates compared to Japan. The effectiveness of FIT-based colorectal cancer screening in reducing mortality is well established. However, the following factors contribute to Japan’s relatively insufficient outcomes: (1) Low detailed examination uptake rate: Among individuals aged 40-69 (the target group for active screening promotion), the detailed examination rate for positive FIT results was 69.9%, according to the 2021 Regional Public Health and Health Promotion Report. (2) Low screening rate: The 2022 Comprehensive Survey of Living Conditions reported a participation rate of only 45.9%. (3) Structural inadequacies: There is no legal mandate for cancer screening in workplaces, leaving some individuals unable to access screenings. Furthermore, there is no comprehensive system to accurately track national screening rates.
The most urgent issue is improving the colonoscopy uptake rate. It is essential to raise awareness that individuals with positive FIT results require detailed examination by colonoscopy. Additionally, measures should ensure that everyone can access colorectal cancer screening through the legislative establishment of workplace cancer screening programs and the introduction of organized screening. Even when adopting colonoscopy as a screening method, it is crucial to achieve not only high accuracy but also high participation rates.
