Result card

  • CUR10: What is the target population for colorectal carcinoma screening with FIT?

What is the target population for colorectal carcinoma screening with FIT?

Authors: Mirjana Huic, Eleftheria Karampli, Silvia Florescu, Cipriana Mihaescu-Pintia

Internal reviewers: Laura Cacciani, Sophie Brunner, Esther Kraft

Target population for CRC screening includes asymptomatic people at average risk, of both genders, age 50-74. Similar age range is currently recommended by the Council of the EU for CRC screening (50-74 years), taking into account that over 100 million men and women in EU are in this age group. Persons in whom age is the only risk factor for CRC are considered to be at average risk {41}. Factors that place individuals at higher risk include a family history of CRC or adenoma, personal history of CRC or adenoma, and inflammatory bowel disease. There is evidence endorsing the provision of CRC screening to average-risk individuals, beginning at age 50, to detect cancers at a favourable stage before they have advanced to a potentially lethal disease state. Individuals in higher risk are not included in the target population in the present report. Recommendations may slightly differ for specific population groups, for example, in the US; the Institute for Clinical Systems Improvement (ICSI) recommends routine colorectal cancer screening for all average-risk patients 45 years of age and older for African Americans or American Indians {42}. In some cases, upper age limits are recommended. The U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF), recommends routine colorectal cancer screening continuing until age 75 years {42} .

In the absence of additional evidence, the age range for a screening programme with iFOBT can be based on the limited evidence for the optimal age range in gFOBT trials {2}. According to the EU Guidelines {2}, the best age range for offering gFOBT screening has not been investigated in trials. Circumstantial evidence suggests that mortality reduction from gFOBT is similar in different age ranges between 45 and 80 years (Level of the evidence IV). The age range for a national screening programme should at least include 60 to 64 years in which CRC incidence and mortality are high and life-expectancy is still considerable. From there the age range could be expanded to include younger and older individuals, taking into account the balance between risk and benefit and the available resources (Level of the evidence VI - B).

Huic M et al. Result Card CUR10 In: Huic M et al. Health Problem and Current Use of the Technology In: Jefferson T, Cerbo M, Vicari N [eds.]. Fecal Immunochemical Test (FIT ) versus guaiac-based fecal occult blood test (FOBT) for colorectal cancer screening [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali; 2014. [cited 3 December 2022]. Available from: