National cancer screening program for colorectal cancer in Korea

Abstract

Colorectal cancer is the 3rd leading cause of cancer-related deaths in Korea, ranking 4th and 3rd among men and women, respectively. It is also the most common cause of cancer-related deaths in women older than 64 years. This study assessed the National Cancer Screening Program for colorectal cancer and examined its efficacy in enhancing public health. The fecal occult blood test (FOBT), a traditional noninvasive colorectal cancer screening test that can be performed on an outpatient basis was replaced with the fecal immunochemical test (FIT) because of the latter's better predictive value. Since 2004, the Government of South Korea has recommended an annual FIT for people aged 50 years and older as the first step in colorectal cancer screening. Individuals who test positive on the FIT are scheduled for follow-up screening procedures, such as colonoscopy or double-contrast barium enema, whereas those who have a negative FOBT are not recommended for colonoscopy. Colonoscopy, as a screening tool in Korea, has definite merits because it is highly accessible to patients and is performed by qualified specialists. Although the domestic colorectal cancer screening rate is relatively stable, there is scope for improvement. Owing to the low cost of colonoscopy and the wealth of skilled endoscopy specialists, the number of intention-to-screen procedures for colonoscopy has increased. As Korea is rapidly becoming an ultra-elderly society, it is time to reconsider the revision of the classical screening program and recommend region-specific, cost-effective guidelines.

Keywords: Colorectal neoplasms; Early detection of cancer; Endoscopy; Immunohistochemistry; Occult blood.

Fig. 1. Annual colorectal cancer incidence and mortality rates in South Korea. The number of colorectal cancer patients in Korea has increased from about 10,000 in 1999 to about 30,000 in 2021, but the number of deaths has increased more slowly, from about 3,700 in 1999 to about 8,900 in 2021.

Fig. 2. Screening performance of the fecal immunochemical test (FIT) for colorectal cancer, by country. The sensitivity of the FIT across countries is about 47%–93% and the specificity is about 83%–96%. The sensitivity of FIT in Korea is lower than in the United Kingdom, the Netherlands, and Germany, but the range of 95% confidence intervals is wide enough that it is not considered to be underperforming compared to other countries.