Colorectal cancer screening

The purpose of the Danish colorectal cancer screening programme is to detect cancer in the colon or rectum at an early or preliminary stage. Early detection is an advantage as it allows for a milder treatment and a higher possibility of cure and sometimes even treatment before the condition turns into cancer. The Danish Health Authorities recommend participation in the national colorectal cancer screening programme.

As participation in colorectal cancer screening can involve both individual benefits and risks, it is important that you make your own choice.

Benefits of colorectal cancer screening

Regular participation in colorectal cancer screening improves the chance of early detection of colorectal cancer. Detecting colorectal cancer in an early or preliminary stages:

• increases the probability of survival
• improves the prospects of lenient surgical treatment and decreases the risk, that supplementary medical treatment is necessary

Risks of colorectal cancer screening

Regular participation in colorectal cancer screening includes the risk of:

• After receiving a positive test result - undergoing a colonoscopy, where no colorectal cancer or other illness is found.
• Experiencing a false sense of security. Receiving a negative test result, where no blood is found in the faeces, cannot rule out the risk of colorectal cancer entirely
• Detecting and treating preliminary stages of colorectal cancer that would otherwise never have developed further, causing unnecessary anxiety and risk of complications
• Experiencing anxiety while waiting for screening results

Who is invited?

All men and women aged 50 to 74 years, are invited to participate in colorectal cancer screening every second year. Participation is voluntary. The first invitation is sent approximately three months after the age of 50. The last invitation is sent between the age of 73 and 75 years.
In case participation is not registered six weeks after invitation to colorectal cancer screening, a reminder is sent to inform that participation is still possible. 

Invitation to colorectal cancer screening does not apply to those, who have had a colorectal cancer diagnosis before the age of 50. Furthermore if colorectal cancer is found based on a screening test, colorectal cancer screening is no longer relevant.

Other target groups

For people with an illness or condition of the colon or rectum, where regular colonoscopic surveillance is performed, it is the surveying department, that decides whether colorectal cancer screening is relevant.  

Unregister

It is possible to unregister from the colorectal cancer screening, either permanently or for a limited time period. To unregister from colorectal cancer screening, please use the box 'Unregister' to your right, in sundhed.dk or by contacting the Department of Public Health Programmes: Link to contact information

In case you regret your un-registration, it is possible to re-enter the colorectal cancer screening programme by re-registration using the box 'Unregister' to your right, in sundhed.dk or by contacting the Department of Public Health Programmes: Link to contact information

Along with the invitation to colorectal cancer screening you receive a self-sampling kit, with which you collect a small sample of faeces. You send the sample to a laboratory, where it is analysed for blood.

The result of colorectal cancer screening will be sent to you and your general practitioner digitally within ten days after you have mailed it. If you do not want your general practitioner to receive the results, you can state so in sundhed.dk or by contacting the Department of Public Health Programmes: Link to contact information

A negative screening result

The result is negative if less than 100µg/l blood is found in the faeces sample. In that case, you will be invited to colorectal cancer screening again in approximately two years unless you have reached the age of 75.

A positive screening result

The result is positive if more than 100µg/l blood is found in the faeces sample. In that case, you will be summoned to an additional examination – colonoscopy, within 14 days from the screening test result.

Invalid screening result technical issues

Sometimes a faeces sample cannot be analysed due to technical issues. In that case you will receive a new invitation and self-sample kit within 10 to 14 days.

Colonoscopy

Blood is found in approximately 5% of the faeces samples, sent to analysis. If blood is found in your faeces sample, you will be summoned to a colonoscopy within 14 days after test result. A colonoscopy is a visual inspection of the interior of the colon, performed with a flexible camera tube inserted through the rectum.

Before the colonoscopy

Inspection of the colon requires careful preparation, removing colonic content to optimise the safety and quality of the colonoscopy procedure. The bowel cleansing starts 4 days before the colonoscopy, by following a restricted diet.

The day before and again 3 hours before the colonoscopy a dose of laxative is taken to optimise the colon cleansing.

During the colonoscopy

A colonoscopy last between 30 minutes and 1 hour and is performed by either a nurse skilled in colonoscopy or a surgical doctor.
As colonoscopy can be an uncomfortable experience, sedation – conscious or unconscious – is used in approximately 60% of the colonoscopic procedures.

After the colonoscopy

After the colonoscopy you might experience discomfort and/or stomach ache for the rest of that day.

If you have had sedatives during the colonoscopy, you are not allowed to drive from the hospital. It is recommended that you have arranged for someone to drive you home, regardless of use of sedation during the procedure.

Result of the colonoscopy

Outcome of a colonoscopy can be:

a) clean colon, where no abnormalities are found. You will receive the next invitation to colorectal cancer screening in 8 years.

b) adenomas are found and removed from the colon or rectum. The further process depends on the number, size and gravity of the adenomas.

In case of low-risk adenomas, you will be invited to your next colorectal cancer screening in two years.

In case of medium or high-risk adenomas, you will enter a colonoscopic surveillance programme for a number of years. When you terminate the surveillance programme, you re-enter the colorectal cancer screening programme, if you have not yet reached the age of 75.

c) cancer is found. If cancer is detected, you will be offered treatment and further surveillance elsewhere. At the same time you will leave the colorectal cancer screening programme.

What is colorectal cancer?

Colorectal cancer is a serious malignant illness. In Denmark approximately 5,000 men and women are diagnosed with colorectal cancer every year.

Early detection of colorectal cancer increases the probability of effective treatment and survival. Symptoms of colorectal cancer includes:

• Visible blood or mucus in the faeces
• Changed bowel habits for a longer period

You should always contact your general practitioner if you experience any symptoms from your bowel. This also applies if you follow the screening programme for colorectal cancer regularly.

What is colorectal cancer screening and how is it carried out?

Colorectal cancer screening is a national screening programme for all men and women aged 50 to 74 years. All citizens resident in the Central Denmark Region in the relevant age group are invited to participate every second year.

Colorectal cancer screening is voluntary and targets men and women without symptoms. The purpose is to detect cancer in the colon or rectum at an early or preliminary stage. Early detection is an advantage as it allows for a milder treatment and a higher possibility of cure and sometimes even treatment before the condition turns into cancer.

Colorectal cancer screening includes a self-sample faeces test, that is analysed for blood. In most cases, no blood is found and the test is negative. In case of a positive test, an additional examination – colonoscopy is needed to dismiss or detect cancer or adenomas.

How do I participate or withdraw from the colorectal cancer screening programme?

All men and women aged 50 to 74 years resident in Central Denmark Region are invited every second year to colorectal cancer screening unless they have actively withdrawn from the programme.

You will receive your first invitation by postal mail within three months after you reach the age of 50.

You will receive your last invitation when you are 73 or 74 years old.

As participation is voluntary, you can always unregister from the programme - permanently or for a shorter period of time (up to two years). If you regret your un-registration, you can re-enter the programme using the box 'Unregister' to your right , in sundhed.dk or by contacting the Department of Public Health Programmes: Link to contact information

Can I participate in the colorectal cancer screening programme if:

• I cannot submit the self-sample test right away?
  YES If you receive your invitation and self-sample kit just before or while on holiday, you can wait to participate, until you return home.
• I am younger than 50 years?
  NO The National Board of Health has stated in the national guidelines for colorectal cancer screening, that the target group for colorectal cancer screening are citizens between 50 and 74 years.
• I am older than 75 years?
  NO The National Board of Health has stated in the national guidelines for colorectal cancer screening, that the target group for colorectal cancer screening are citizens between 50 and 74 years.
• I have been diagnosed with a chronic bowel illness?
  MAYBE If you have been diagnosed with a chronic bowel illness e.g. Morbus Crohn or Colitis Ulcerosa, you need to consult the doctor in charge of surveying your illness, to decide whether colorectal cancer screening is relevant for you.
• I have previously been diagnosed with colorectal cancer?
  NO Citizens who have previously been diagnosed with colorectal cancer are not invited to participate in colorectal cancer screening. If you have previously been diagnosed with colorectal cancer og currently are in treatment for colorectal cancer, the gastrointestinal department is in charge of treatment and further surveillance.
• I have a mental or physical handicap
  YES in most cases. If you need help to collect the faeces sample you can contact municipal health care department or your general practitioner for assistance.
  In some cases a mental or physical handicap prevents the possibility to undergo a colonoscopy. In that case you or a guardian can consult your general practitioner, whether colorectal cancer screening is relevant.