Table 2.
Classification of EHIS-participating countries by type of CRC screening programs.
| Country | Structure of screening program | Year of program initiation (& possibly, termination) | Age group | Type of screening test | Screening interval | Referenceh | Category according to gFOBT/FIT offer |
|---|---|---|---|---|---|---|---|
| Belgium (Flemish region) | Organized | 2013–2018 | 56–74 | FIT | 2 yrs | 1,2 | A |
| 2018–2020 | 53–74 | ||||||
| 2020 | 50–74 | ||||||
| Belgium (Wallonia/Brussels) | 2009–2016 | 50–74 | gFOBT | ||||
| 2016 | FIT | ||||||
| Croatia | Organized | 2007 | 50–74 | gFOBT | 2 yrs | 3–5 | |
| Denmark | Organized | 2014 | 50–74 | FIT | 2 yrs | 6 | |
| Lithuania (Vilnius and Kaunas) | Organized | 2009–2014 (pilot) | 50–74 | FIT | 2 yrs | 7,8 | |
| Lithuania (All regions) | 2014 | ||||||
| The Netherlands | Organized | 2014 | 55–75 | FIT | 2 yrs | 9 | |
| Slovenia | Organized (pilot) | 2008–2009 | 50–69 | FIT | 2 yrs | 10,11 | |
| Organized | 2009–2015 | 50–74 | |||||
| 2015 | |||||||
| Czechia | Organized (pilot) | 1979–1998 | 45–60 | gFOBT | 2 yrs | 12–15 | B |
| Opportunistic | 2000–2009 | 50–54 | |||||
| Opportunistic | 2009 | 50–54 | FIT/Colo | 1 yr | |||
| Opportunistic | 2009 | 55+ | FIT/Colo | 2 yrs/10 yrs | |||
| Organized | 2014 | 50+ | FIT | 2 yrs | |||
| Finlanda | Organized | 2004–2016 | 60–69 | gFOBT | 2 yrs | 16,17 | |
| Organized (pilot) | 2019–2027 | 56–74 | FIT | ||||
| Hungary (Csongrád county) | Organized | 2013–2015 | 50–70 | FIT | 2 yrs | 18,19 | |
| Hungaryb | Organized | 2018 | |||||
| Ireland | Organized | 2012 | 55–74 | FIT | 2 yrs | 3,20,21 | |
| Italy | Organized | 1982–1996 | 50–69 | gFOBT | 2 yrs | 22–24 | |
| Organized | 1996 | 50-70/74 | FIT | ||||
| Italy (Piedmont and Veneto regions) | Organized | 2003/2004 | 58–60 | FS | Once only | ||
| Malta | Organized | 2012 | 55–66 | FIT | 2 yrs | 5,25 | |
| NR | 55–74 | 2 yrs | |||||
| Portugal | Opportunistic | NR | 50–74 | FIT/Colo | 1 yr/10 yrs | 12,26–28 | |
| Portugal (Alentejo and Central regions) | Organized | 2009–2018 | 50–70 | gFOBT | 2 yrs | ||
| 2018 | FIT | ||||||
| Portugal (Northern region) | Organized (pilot) | 2016–2018 | 50–74 | FIT | |||
| Organized | 2018 | ||||||
| Serbia (32 municipalities) | Organized | 2013–2014 | 50–74 | FIT | 29,30 | ||
| Spain | Organized | 2000–2010 | 50–69 | gFOBT | 2 yrs | 3,12,31–33 | |
| 2010 | FIT | ||||||
| Sweden (Regions Gotland and Stockholm) | Organized | 2008–2015 | 60–69 | gFOBT | 2 yrs | 5,24,34 | |
| 2015 | FIT | ||||||
| Sweden (Region Skåne) | 2021 | 60–74 | FIT | ||||
| Austria (Burgenland) | Organized | 2003 | 40–80 | FIT | 1 yr | 24,35 | C |
| Austria (Vorarlberg)c | 2007 | 50+ | Colo | 10 yrs | |||
| Austria (All regions) | Opportunistic | 1980 | 40+ | gFOBT, | 1 yr | ||
| 2005 | 50+ | Colo | 7–10 yrs | ||||
| Germany | Opportunistic | 1977–2002 | 45+ | gFOBT | 1 yr | 36–38 | |
| Opportunistic | 2002–2017 | 50–54 | gFOBT | 1 yr | |||
| 2017 | FIT | ||||||
| Opportunistic | 2002–2017 | 55+ | gFOBT/Colo | 2 yrs/10 yrs | |||
| 2017 | FIT/Colo | ||||||
| Organized | 2019 | 50-54/55+ | FIT | 1 yr, then 2 yrly | |||
| Organized | 2019 | 50+(men); 55+(women) | Colo (up to 2 screenings) | 10 yrs | |||
| Greece | Opportunistic | NR | 50–74 | gFOBT | NR | 3,33 | |
| Colo | NR | ||||||
| Latvia | Opportunistic | 2005 | 50–74 | gFOBT | 1 yr | 3,39 | |
| Slovakia | Opportunistic | 2002–2019 | 45–75 | gFOBT/Colo | 2 yrs | 40 | |
| Organized (pilot) | 2019–2021 | 50–75 | FIT | ||||
| Organized | 2021 | FIT | |||||
| Bulgariad | Opportunistic | 2009 | NR | gFOBT | NR | 41 | D |
| No program | 2009 | NA | NA | ||||
| Cypruse | No program | NA | NA | NA | NA | 42 | |
| Estoniaf | Organized (Pilot) | 2016 | 60–69 | FIT | 2 yrs | 43,44 | |
| Organized | 2022 | ||||||
| Iceland | Opportunistic | NR | 50+ | Colo | NR | 45 | |
| Luxembourg | Opportunistic | 2005- | 50+ | gFOBT/Colo | NA | 12,46 | |
| Organized (Pilot) | 2016–2019 | 55–74 | FIT/Colo | 2 yrs/10 yrs | |||
| Organized | 2021 | FIT | 2 yrs | ||||
| Norway (Østfold, Akershus & Buskerud Counties) | Organized (pilot) | 2012–2018 | 50–74 | FS/FIT | 2 yrs (FIT), Once (FS) | 47–50 | |
| Norway (All regions)g | Organized | 2022 | 55+ | FIT | 2 yrs | ||
| Poland | Opportunistic | 2000–2011 | 50–66 | Colo | 10 yrs | 51–53 | |
| Poland (25 of 380 counties) | Organized (pilot) | 2012 | 55–64 | Colo | Once only | ||
| Romania | No program | NA | NA | NA | NA | 54 |
The countries are arranged in alphabetical order within each category based on the type of CRC screening programs offered with regards to fecal tests. Category A, countries with nationwide organized screening fully implemented using fecal tests; Category B, countries with organized programs with fecal tests partially rolled out or with regional coverage only; Category C, countries with opportunistic programs with fecal test; category D, countries with no program with fecal tests or a small-scale pilot program only.
gFOBT, guaiac-based fecal occult blood test; FIT, fecal immunochemical test; FS, flexible sigmoidoscopy; Colo, colonoscopy; NA, not applicable; NR, not reported; yr(s), year(s).
In Finland, following the pilot of FIT in 2019–2021 in volunteer municipalities, the Government Decree on Screenings was amended to make screening available nationwide from 2022 onwards. Screening every 2 years was initially introduced among 60–68-year-olds and will be expanded to all target age groups (56–74) by 2031 (https://cancerregistry.fi/screening/colorectal-cancer-screening/).
In Hungary, eligible persons are invited by the National Public Health Institute based on their association with GPs who are participating in the screening program. The GPs are reimbursed per screened individual (Supplementary Item S6, ref. 19).
In Vorarlberg, screening is only available for insured individuals according to the protocol (Supplementary Item S6, ref. 24).
In Bulgaria, general practitioners (GPs) were responsible for the referral of patients for gFOBT until 2009, when the opportunistic program was discontinued due to poor compliance by both the practitioners and the eligible persons (Supplementary Item S6, ref. 41).
In Cyprus, a small-scale pilot program was said to have been conducted in 2013; however, no further information has been provided about the continuation of any screening program since then.
In Estonia, an organized screening program was piloted among insured persons from 2016 until 2022, when it was expanded to all eligible individuals.
In Norway, organized screening with FIT was piloted between 2012 and 2018 in Østfold, Akershus, and Buskerud Counties. Since May 2022, the Norwegian Cancer Registry has administered a nationwide CRC screening with FIT every 2 years from age 55. The program is expected to be replaced with a once-only screening colonoscopy after five FIT screening rounds, when colonoscopy capacity would have improved to cover the entire target population (Supplementary Item S6, ref. 47).
Reference list for Table 2. See Supplementary Item S6 in the Supplementary document.