Recommendations on population screening for colorectal cancer in New Zealand

The National Advisory Committee on Health and Disability invited a working party to make recommendations on population screening for colorectal cancer in New Zealand. Recent results from randomised controlled trials of screen ing with guaiac faecal occult blood tests have provided evidence that popul ation screening could reduce mortality from colorectal cancer. However, giv en the modest potential level of benefit, the considerable commitment of he alth sector resources, and the small but real potential for harm, the worki ng party does not recommend population screening for colorectal cancer with faecal occult blood tests in New Zealand. The working party does not recom mend pilot colorectal cancer screening programmes in New Zealand because pi lot programmes cannot address the issues of concern: the modest potential b enefit and the small, but real, potential for harm. The working party does not recommend faecal occult blood testing as a screening test for colorecta l cancer in average-risk individuals outside a population screening program me. Those requesting screening by faecal occult blood test should be given information about the potential risks and benefits. Follow-up bowel investi gations in the public health system cannot be guaranteed without an increas ed allocation of resources. As there is yet no evidence from randomised con trolled trials that screening with flexible sigmoidoscopy, colonoscopy or d ouble-contrast barium enema produces a reduction in colorectal cancer morta lity, the working party does not recommend population screening with these modalities. Wider consultation and further consideration should be undertak en to develop appropriate advice on surveillance recommendations for groups identified to be at increased risk of colorectal cancer. These decisions s hould be reviewed as evidence of benefit from new types of faecal occult bl ood test and other screening modalities becomes available. The working part y recognises that colorectal cancer is an important cause of morbidity and mortality and recommends that New Zealand participate in international rese arch in this area.