Globally, colorectal cancer (CRC) is one of the most commonly diagnosed cancers and ranks as the second leading cause of oncological death worldwide. Asia contributes to more than half of the incident cases and deaths. In 2004, the Taiwanese government launched a nationwide organized CRC screening program following a successful pilot program. The fecal immunochemical test (FIT) is offered biennially to individuals aged 50 to 69 (extended to 75 in 2013). Initially, the screening coverage rate was 21.4%, with a repeat screening rate of 28.3% during the inaugural 5 years (2004-2009). As of 2014, the 10th year after the commencement of this program, these rates had improved to 56.6% and 52.3% respectively and it was demonstrated that CRC mortality and the incidence of advanced-stage CRC have reduced by 35% and 29% respectively, when comparing those who did and did not participate in FIT screening.
Nevertheless, there are several challenges and obstacles that need to be addressed. First, interval cancers, occurring either after a negative FIT or colonoscopy without the diagnosis of CRC, have more unfavorable clinical outcomes, significantly impacting the effectiveness of screening. Second, the rate of regular participation in the program is still not satisfactory. Both the government and professional societies should work towards increasing public awareness of CRC. Third, some individuals are not compliant with colonoscopy after a positive FIT, greatly affecting the effectiveness of screening. Fourth, there is a rising trend of young-onset CRC, sparking debate on whether the age for initiating screening should be lowered. In response to such a surging trend, Taiwanese government has recently announced lowering the age of initiating screening to 45, starting from 2025. Finally, long-term financial support for this program is essential for its success, especially in the era of an aging population and the trend of including younger age groups in the screening population. All of these challenges require collaboration between the screening organizers, distributors, and professional societies for effective solutions. |
