The average risk for colorectal cancer in the European population is estimated as a 3.5% cumulative chance of having this disease in a person reaching the age of 74. In 10% of the cases the disease occurs on a genetic base. Since the detection and surveillance of genetic cancer is well established, these cases are not addressed by screening policies. Otherwise 90% of bowl cancer cases are so called sporadic cancers which occur in persons with either an average risk or a slightly increased risk e.g. if there is a close relative with the same disease. In the latter condition the cumulative 0-74 year chance of developing a cancer increases up to 10%. Screening policies are only addressed at persons with sporadic cancer.
Recommendations for colorectal cancer screening usually distinguish between people at average risk and people at increased risk such as people in one of the following situations:
• People with a family history of “familial adenomatous polyposis” (FAP)
• People with a family history of “hereditary nonpolyposis colorectal cancer” (HNPCC)
• People with a history of adenomatous polyps
• People with a history of colorectal cancer
• People with inflammatory bowel disease
This distinction is necessary because people under these conditions have to be screened with a different protocol than the average risk individual. Around 70-80% of a screening group are people at average risk and 20-30% people at increased.
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