Current Status and Challenges of Colorectal Cancer Screening and Colonoscopy in Japan

Abstract

In Japan, population-based colorectal cancer screening using the fecal immunochemical test was introduced in 1992. However, colorectal cancer mortality and incidence remain high, indicating that numerous challenges persist in colorectal cancer screening. One key issue is the urgent need to establish a nationwide data management system to elevate Japanese screening programs to the level of organized screening programs. To improve colorectal cancer screening in Japan, it is essential to base discussions on findings and data from Japanese research. Therefore, this paper discusses appropriate modalities for colorectal cancer screening based on Japanese research data. The fecal immunochemical test-based screening is a noninvasive and effective method; however, the data on its diagnostic accuracy and interval cancer suggest limitations, particularly in detecting right-sided colorectal neoplasia. To compensate for these limitations, further utilization of total colonoscopy warrants discussion. Screening with total colonoscopy is expected to be highly effective and cost-efficient; however, challenges remain in ensuring its acceptability and maintaining quality standards. Moving forward, it is desirable to establish an optimized screening framework that appropriately combines the fecal immunochemical test and total colonoscopy, with consideration to risk-stratified screening approaches.