Analysis of selected studies extracted from the basic literature search. Three articles were found to be relevant to this question and one document with guidelines.

According to the insight that was gained through the literature review, it can be concluded that the most critical points in management are:

•             To ensure that all eligible target population is invited and well informed about the colorectal cancer, colorectal cancer screening and the screening process;

•             To ensure that screening process is conducted strictly according to the rules of procedure (the quality of process depends also on the communication, coordination etc.);

•             To ensure an adequate and timely follow-up or treatment for those who need it;

•             To ensure the availability of data (data management system);

i-FOBT requires assurance of consistency in analytical performance by the adoption and application of rigorous quality assurance procedures. Manufacturer’s Instructions for Use must be followed. Laboratories should perform daily checks of analytical accuracy and precision across the measurement range with particular emphasis at the selected cut-off limit. Rigorous procedures need to be agreed and adopted on how internal quality control data is interpreted and how the laboratory responds to unsatisfactory results. Performance data, both internal quality control and external quality assessment data, should be shared and reviewed by a Quality Assurance team working across the programme. Sufficient instrumentation should be available to avoid delays in analysis due to instrument failure or maintenance procedures {4}.

The problem can occur in relation to the inappropriate implementation of screening, which can result in grossly misleading results {4}. Another challenge is related to an insufficient participation to an appropriate follow-up diagnostic evaluation in cases with a positive fecal occult blood test (FIT) result {33}.

The problem can also represent a limited amount of financial, technical, staff and time resources.

Therefore in an organized screening program, besides a health care team, a management team acts an important role for its implementation {8, 27}. In colorectal cancer, multidisciplinary management is strongly recommended. In the UK for example (already mentioned in ORG3), the organisation of the colorectal screening programmes is overseen by a programme manager, who reports to a national or regional screening coordinator responsible for all screening programmes {4}.

The professional and organisational managers of a screening programme must have sufficient authority and autonomy, including an identified budget and sufficient control over the use of resources to effectively control the quality, effectiveness and cost-effectiveness of the programme and the screening service. The institutional structure must facilitate effective management of quality and performance {4}.

One of the management opportunities could also be located within the development of a European external quality assessment scheme that would facilitate Europe-wide quality assurance of occult blood testing and enhance the reproducibility of testing within and between countries providing population screening {4}.