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Introduction: Colorectal Cancer (CRC) presents a significant and sustained challenge for many health-care systems. With the European incidence increasing at a variable rate for men (51.9 to 59.0/100,000) and women (35.0 to 35.6 /100,000) between 1995 & 2006, CRC is a major source of overall cancer mortality. One area of management that has experienced considerable deficits in financial and political investment, are initiatives concerning nationally-cohesive colorectal screening policy. Indeed, the distinct absence of concerted screening initiatives has had a considerable effect on stage of CRC diagnosis and subsequent patterns of survival. More specifically, with CRC 5- year survival rates being lowest within common cancer, second only to lung cancer (CRC: 53.7% and Lung cancer: 12.1 %).
 Objective: In view of capturing the current state of CRC management within a 21 European country sample, this paper aims to assess the current status of colorectal screening policy. Furthermore, this body of research will identify and critically assess structural barriers to protocol implementation within the given system-wide context.
 Methodology: Using information collected from primary-source questionnaires, data was collected from a 21countries. Respondents were asked to determine discrepancies between theoretical practices of colorectal cancer screening policy and critical facets of policy implementationResults: Despite the uniform existence of informal screening practices across Western and Eastern Europe, less than 50% of countries participate in nationally-coordinated screening policies. Variability concerning the target age-range in which screening practices should be delivered spans from a starting age of 50 yrs in Germany to that of 60 yrs in Finland and UK. Cost-effectiveness considerations and issues concerning national responsibility frame national screening decision. Furthermore, differences with regard to diversity in screening processes are increasingly apparent within countries; with FOBT used uniformly, FS and CL predominating in Italy and Germany. When addressing problems of implementation, existing inequalities in clinical capacity, between countries, present a significant obstacle to screening implementation. Furthermore, disparities regarding access to screening facilities are still pervasive within many environments and are contingent upon traditional aspects of health-system finance, delivery and organisation.
 Conclusion: The lack of nationally concerted screening policies still seems to be pervasive within Europe. Inability to target optimum age for screening, presents a significant problem with regard to early CRC diagnosis. Additionally, clear inequalities in clinical capacity and lack of appropriate technical skills set represents a significant barrier to uniform screening practices.

99th AACR Annual Meeting-- Apr 12-16, 2008; San Diego, CA