Colorectal Cancer Screening and Early Detection in Europe: Progress, Gaps, and the Path Forward – Building Hope Through Early Detection

As we mark Colorectal Cancer (CRC) Awareness Month, this article highlights the latest available data from countries involved in recruitment within the DIOPTRA Project. Together, these insights illustrate both the progress made and the persistent gaps in colorectal cancer screening and early detection across Europe.

Despite differences in health systems, screening models, and participation levels, one message is clear: early detection saves lives, and increasing screening uptake remains one of the most effective tools to reduce colorectal cancer mortality.

Austria: High Uptake Ahead Of Organised Rollout

Even prior to the formal recommendation to implement a population-based colorectal cancer screening programme in 2023, Austria showed some of the highest self-reported screening participation rates in Europe, with uptake increasing from 59% in 2014 to 64% in 2019. Colorectal cancer incidence and mortality are below EU averages, and avoidable mortality has decreased over time.
Nonetheless, marked gender disparities remain, with men participating significantly less than women. The national recommendation for organised screening, including discussions on lowering the starting age at 45, represents a key opportunity to improve equity and ensure long-term sustainability.

Belgium: Progress in Screening Amid Regional Differences

In Belgium, CRC screening coverage was moderate in 2021, with 53.6 % of the eligible population (aged 50–74) having been screened either within the organised programme (32.6%) or outside it (21.1 %). There were notable regional disparities, with coverage in Flanders roughly twice as high as in Brussels and Wallonia, reflecting differences in implementation and uptake. Screening participation also correlates with socio-economic status: people with higher incomes tend to take part more in CRC screening than those with lower incomes.
Recent data from the Belgian Cancer Registry (incidence year 2023) show that CRC remains the third most frequent cancer in Belgium. Encouragingly, long-term trends suggest that the risk of both diagnosis and mortality is decreasing: in men the average annual change in risk of diagnosis is about -1.6 % and in women about -1.3 %, while mortality risk is declining by about -2.9 % per year in men and -2.7 % per year in women, which likely reflects ongoing improvements in early detection, including screening, and treatment.

Croatia: Opportunities to Strengthen Early Detection and Save Lives

Croatia faces one of the highest cancer incidence rates in Europe, with colorectal cancer a leading cause of cancer-related death. Screening coverage reached 26% in 2023, still well below the EU average, with notable disparities by sex, education, income, and geography.
Encouragingly, Croatia has established organised screening programmes supported and fully covered by universal health insurance, ensuring access for all eligible citizens. Further increasing participation—particularly among men and lower-educated groups—could significantly reduce avoidable mortality, which remains well above EU levels.

Cyprus: Building the Foundations for Change

Until recently, Cyprus had one of the lowest colorectal cancer screening participation rates in the European Union. In 2019, only around 22% of eligible adults aged 50–74 had undergone screening. Screening was largely opportunistic and primarily based on colonoscopy, often requiring out-of-pocket payment. This approach created significant financial and access barriers, limiting participation and contributing to delayed detection of colorectal cancer.
However, the situation has changed. As of May 2025, Cyprus has officially launched a national, population-based colorectal cancer screening programme. The programme is based on the faecal immunochemical test (FIT), which detects small amounts of blood in stool samples. It targets men and women aged 50–74 and is offered free of charge through the General Healthcare System (GeSY).
Under the new system, eligible individuals receive personalised invitations along with instructions for completing the FIT test at home. Samples are returned for laboratory analysis, and individuals with positive results are referred for a follow-up colonoscopy. This shift from opportunistic colonoscopy to an organised, accessible FIT-based programme is expected to significantly increase participation rates and improve early detection outcomes in Cyprus.

Denmark: Strong Impact Through Organised Screening

Denmark’s well-established, population-based colorectal cancer screening programme demonstrates the power of organised prevention. Participation stabilised at 60% in 2024, following several years of minor decline, with encouraging increases among first-time invitees. Since the programme’s launch in 2014, over 10,000 colorectal cancers have been detected through screening, with nearly two-thirds diagnosed at an early stage (65.8%), when treatment is less invasive and outcomes are significantly better.
While Denmark has introduced targeted measures, such as multilingual information materials and tailored outreach, data show that social inequality in screening uptake remains. This underlines a key lesson: overall participation can be acceptable while inequalities persist.

Greece: Transitioning Towards Population-based Screening

Historically, colorectal cancer screening in Greece has been largely opportunistic, delivered mainly through the private sector. In 2019, only 28% of individuals aged 50-74 reported having been screened¹. Long waiting times in the public sector and the absence of a population-based programme have limited uptake.
The announcement of population-based cervical and colorectal cancer screening programmes in 2024 marks an important turning point. Specifically, the national public health prevention programme “Prolamvano” was launched in October 2024, targeting 2.8 million men and women aged 50-69² who were granted free FIT kits and were automatically prescribed a colonoscopy in case of a positive test. Although official data are not yet available, the Greek Ministry of Health announced on February 2025 that more than 600,000 citizens had enrolled by acquiring a FIT kit for self-testing, with more than 15,000 forwarded for a colonoscopy³. Although a repeat screening interval has not been formally established yet, effective implementation and timely access will be key to reducing avoidable mortality, which has remained relatively stable over the past decade.

Slovenia: A Model for High Participation and Equity

Slovenia stands out for its well-established, population-based screening programme, implemented through the national SVIT programme (a health programme intended for the prevention and early detection of colorectal cancer), in line with European quality standards. Participation rates are among the highest in the EU (with data for eligible population ranking close to 65%), with about 70% of cancers diagnosed at early stages and avoidable mortality declined substantially, faster than the EU average.
Targeted communication campaigns, strong public trust, and national coordination have contributed to improved survival and reduced inequalities, offering valuable lessons for other countries seeking to strengthen screening uptake.

Spain: Screening Advances, With Regional Gaps to Address

In Spain, CRC remains one of the malignancies with the greatest population impact. For 2026, the Spanish Network of Cancer Registries (REDECAN) estimates more than 40.000 new cases of CRC, maintaining it among the most frequently diagnosed tumors in the country. Its prevalence continues to be high, and survival shows clear sex‑related differences: overall, 5‑year survival is higher in women, approaching 69%, while in men it is closer to 65%. This sustained improvement is closely linked to the implementation of screening programmes, which have enabled earlier detection and contributed to better clinical outcomes.
Since 2014, CRC screening has been integrated into Spain’s national health system, with all autonomous communities implementing population‑based programmes. Participation has progressively increased, reaching 32% of the eligible population in 2020, an improvement of ten percentage points since 2017. Despite this progress, uptake remains below the acceptable threshold of 45% and far from the national target of 65%. Substantial regional variability persists, with participation ranging from 19% to 74%, highlighting the need to strengthen equity in access and to enhance overall engagement in screening initiatives.
Spain’s experience illustrates how the progressive expansion of organised screening programmes can meaningfully reduce preventable colorectal cancer mortality, particularly when participation increases and early detection becomes more consistent across regions.

Shared Challenges, Shared Opportunities

Across countries, common patterns emerge: lower participation among men, younger age groups, socially disadvantaged populations, and people with a migration background. Uptake is higher where organised, population-based programmes are in place. Evidence shows that general, one-size-fits-all campaigns often benefit those already likely to participate, while the most vulnerable groups require targeted, culturally adapted, and locally grounded approaches. Denmark’s recent initiatives, Slovenia’s use of ambassadors, and Croatia’s registry-based invitations all demonstrate the importance of combining universal programmes with tailored interventions.

Why Early Detection Must Remain a Priority

Colorectal cancer develops slowly, often over many years. Screening not only detects cancer earlier but can prevent it entirely by identifying and removing precancerous lesions. Countries with higher screening uptake consistently show:

Lower rates of late-stage diagnosis
Better survival outcomes
Declining avoidable mortality

Yet participation remains the single most important determinant of success. Even the best-designed screening programme cannot reduce mortality if large segments of the population do not take part.

Looking Ahead

Across Europe, countries are building momentum. They are launching new population-based programmes, strengthening invitation systems, and increasingly using digital tools to support participation. They will sustain progress only if they place equity at the centre of screening strategies. The evidence is clear: colorectal cancer screening works. The challenge now is ensuring that everyone, regardless of income, education, gender, or place of residence, can benefit from early detection.

Knowledge is power. Screening is Prevention. This guiding principle of the DIOPTRA Project reminds us that informed participation saves lives and strengthens communities across Europe.