title: [Prevention and early detection of colorectal cancer in average risk population--summary of a meeting and the Israeli gastroenterology policy].
abstract: BACKGROUND
  Colorectal cancer (CRC) is a leading cause of cancer mortality, with a lifetime risk of 5-6% and mortality rate of nearly 50%. About 75% of the cases occur in average-risk individuals. CRC ideally fulfills the criteria for organizing a mass-screening program: It is common and lethal, cancer is preceded by a pre-malignant lesion (adenoma) and transition from precursor to malignancy develops over years, providing an opportunity for intervention. It is well established that removal of adenomas (polypectomy) prevents CRC and CRC-related death in up to 90% of the cases. In Israel, we lack a clear policy for CRC screening and prevention by the health authorities. A meeting on this subject was held at the Israel Cancer Association, attended by the Minister of Health and leading figures in gastroenterology, oncology and public health.
  
  
  OBJECTIVE
  To summarize the meeting and the Israeli Gastroenterology Association policy.
  
  
  CONCLUSIONS
  Current data on fecal occult blood test, sigmoidoscopy, and colonoscopy was presented, including the reduction of cancer incidence and mortality, safety and cost-effectiveness of each modality. Worldwide and Israeli results on colonoscopy in average-risk persons age 50-75, demonstrated a considerable prevalence of neoplasia, a low morbidity rate, no mortality and a high cost-effectiveness. Based on these results and the literature evidence of up to 90% reduction of CRC mortality following colonoscopy, CRC justifies all the criteria for organizing a prevention program by the health authorities for average-risk population age 50-75. Screening colonoscopy for CRC prevention should be included in this program.
authors.affiliation: Israeli Gastroenterology Association, Gastroenterology Department, Sourasky Medical Center, Tel-Aviv.
authors.forename: Hana
authors.initials: H
authors.lastname: Strul
authors.forename: Rami
authors.initials: R
authors.lastname: Elyakim
authors.forename: Zamir
authors.initials: Z
authors.lastname: Halpern
authors.forename: Nadir
authors.initials: N
authors.lastname: Arber
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008403:Mass Screening / Q000458:organization & administration; D008875:Middle Aged; D009017:Morbidity; D015995:Prevalence; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D012955:Societies, Medical