Review Colorectal cancer prevention in Europe: Burden of disease and status of screening programs E. Altobelli a,b, ⁎, A. Lattanzi a , R. Paduano a , G. Varassi c , F. di Orio a a Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy b Epidemiologic and Social Marketing Unit, AUSL 4 Teramo, Italy c AUSL 4, Teramo, Italy abstract article info Available online 14 February 2014 Keywords: Cancer Colorectal Screening EU28 Colorectal cancer is a major public health challenge worldwide. In Europe it is the first malignancy in terms of inci- dence and the second in terms of mortality in both genders. Despite evidence indicating that removal of premalignant and early-stage cancer lesion scan greatly reduce mortal- ity, remarkable differences are still found among countries both in terms of organized screening programs and of the tests used. In 2003 the European Council recommended that priority be given to activation of organized cancer screening programs, and various states have been making significant efforts to adopt effective prevention programs with international quality standards and centralizing screening organization and result evaluation. After a 2008 European Union report on thestate of screening program, activation highlighted that little more than 50% (12/22) of Member States had colorectal cancer screening programs, Screening programs have been adopted or earlier pilot projects have been extended nationwide. This paper examines the state of activation and the screening strategies of colorectal cancer screening programs in EU States as of July 2013. © 2014 Elsevier Inc. All rights reserved. Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Materials and methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 EU28 epidemiological data sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Screening methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 FOBT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Endoscopic examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 CRC screening in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Adherence to screening: inequalities and characteristics influencing compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Socio-demographic factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Psychosocial factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 System factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Conflicts of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Preventive Medicine 62 (2014) 132–141 ⁎ Corresponding author at: Piazzale Salvatore Tommasi 1, 67100, Coppito (Aq), Italy. Fax: +39 862433425. E-mail addresses: emma.altobelli@cc.univaq.it (E. Altobelli), amedeo.lattanzi@aslteramo.it (A. Lattanzi), riccardo.paduano@gmail.com (R. Paduano), giuvarr@gmail.com (G. Varassi), ferdinando.diorio@cc.univaq.it (F. di Orio). http://dx.doi.org/10.1016/j.ypmed.2014.02.010 0091-7435/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed