Evolution of colorectal cancer epidemiology in a setting of opportunistic screening. A 20 year national survey in Luxembourg.

Invasive colorectal cancer (CRC) is the second leading cause of cancer death in Luxembourg. There is no organized screening pro- gramme in Luxembourg. This study aims to obtain a precise epide- miological description of the evolution of invasive CRC and high grade intraepithelial neoplasia (HGIEN) from 1990 to 2009, extrac- ted from the database of the Morphologic Tumor Registry. Tumor stages and observed survival rates were also recorded. They were compared to the change in use of colonoscopic procedures. During the 20-year period, 4810 invasive CRC cases and 1180 HGIEN were recorded. Incidence rose from 1990 to 2005 and declined thereafter, especially in women. A sharp rise in HGIEN was noted from 2004 onwards, paralleling the rates of colonoscopies. 76 % of CRC cases were found in advanced stages pT3 and pT4. The pT stage distribu- tion did not change over the observation period. Observed survival rates improved during the study period. Conclusion: Under oppor- tunistic screening conditions, mainly through colonoscopy, the incidence of CRC was declinig in recent years, whereas HGIEN incidence is rising in Luxembourg. Tumor pT staging remained unchanged whereas survival rates improved. We conclude that -opportunistic- screening- is- of- little- benefit- for- CRC- prevention. A national organized screening programme is warranted. (Acta gastroenterol. belg., 2013, 76, 25-33).