2025 Volume 63 Issue 6 Pages 991-1001
The two-day fecal immunochemical test (FIT)-based colorectal cancer screening program, introduced in 1992, has been criticized for potentially lacking sufficient effectiveness. As a result, there is growing discussion around adopting colonoscopy as a more effective screening method for colorectal cancer prevention.
Although the effectiveness of colonoscopy has been demonstrated in numerous case-control and cohort studies, its efficacy is still being verified through ongoing randomized controlled trials. In Germany, where organized colonoscopy screening has already been implemented, individuals can choose between FIT and colonoscopy, with the option to undergo up to two colonoscopies at 10-year intervals. Strict quality control measures are in place, and while the annual participation rate remains relatively low at 2-3%, the program has been reported to significantly reduce both the incidence and mortality of colorectal cancer.
In contrast, Poland introduced a screening program based solely on colonoscopy. However, due to low public acceptance and limited access, the program has not produced sufficient results, prompting the need for additional improvement measures.
To introduce population-based colonoscopy screening in Japan, it is essential not only to verify its impact on mortality reduction but also to establish a precise and robust system capable of reliably performing colonoscopy screening. Discussions must proceed in parallel with efforts to strengthen the overall cancer screening infrastructure, including the implementation of organized screening programs.
