Prospects for population colorectal cancer screening in New Zealand.
OBJECTIVE
In 2005 the National Screening Unit of the Ministry of Health appointed a Colorectal Screening Advisory Group to provide independent strategic advice and recommendations on population screening for colorectal cancer (CRC) in New Zealand.


METHODS
Evidence-based review of relevant literature and assessment of CRC screening using the New Zealand Criteria to Assess Screening Programmes.


RESULTS
Guaiac faecal occult blood test (FOBTg), immunochemical FOBT (FOBTi), flexible sigmoidoscopy, colonoscopy, and CT colonography were considered. FOBTg is the only test supported by high quality evidence from randomised controlled trials but has limited sensitivity and achieves modest CRC mortality reduction over time. FOBTi has higher analytical sensitivity than FOBTg and would be assumed to achieve greater mortality reduction. A CRC screening programme requires substantial planning and resources. Currently public hospitals cannot deliver timely diagnostic or surveillance colonoscopy.


CONCLUSIONS
The Advisory Group recommends that a feasibility study of CRC screening using FOBTi be undertaken. This would help determine the performance of the FOBTi in the New Zealand population and whether the New Zealand health system could support an acceptable, effective and economically efficient CRC screening programme. To optimise the diagnosis and treatment of colorectal cancer there is an immediate need to expand colonoscopy services and to ensure that throughout New Zealand the treatment outcomes for CRC, both surgical and oncological, meet international standards.
Parry
Susan
S
Middlemore Hospital, Otahuhu, Auckland. sparry@middlemore.co.nz
Richardson
Ann
A
Green
Terri
T
Marshall
Betsy
B
Bissett
Ian
I
Bloomfield
Ashley
A
Chadwick
Vinton
V
Cunningham
Chris
C
Findlay
Michael
M
Greer
Barbara
B
McMenamin
John
J
Strid
Judi
J
Robertson
Greg
G
Teague
Clinton
C
D023881:Colonography, Computed Tomographic; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D006801:Humans; D008403:Mass Screening / Q000639:trends; D009520:New Zealand; D009780:Occult Blood