Colorectal cancer screening program: no health gains without effective implementation and financing
Abstract
Introduction: Colorectal cancer (CRC) represents the second highest cancer incidence in Portugal. A Colorectal Cancer Screening Program (PRCCR) was implemented in 2019 to achieve early diagnosis. Yet, its effective implementation has never been evaluated.
Objectives: To evaluate PRCCR implementation at a Local Health Unit (ULS), which groups hospitals and primary care centers under a common structure. We characterize new CRC cases diagnosed between 2019 and 2024, and analyse associated costs of the PRCCR implementation with different scenarios.
Methods: Observational, descriptive, retrospective study with cohort analysis. Analysis included 55,338 PRCCR activity records and 245 diagnosed CRC cases. Operational indicator analysis, characterization of new cases and scenario analysis were conducted.
Results: Only 37.9% of records showed valid screening results. Of positive tests, 59.2% were referred for colonoscopy and only 31.0% of requested colonoscopies were performed according to the guidelines. Advanced stages (III/IV) represented 71.1% of cases. Scenario analysis demonstrated that increased participation results in growing losses for ULS, due to increased screening implementation costs and treatment of identified cases, inadequately compensated and incentivized in the current financing model.
Conclusions: Significant operational failures and misalignment between the incentive model and public health objectives were identified, compromising program effectiveness and sustainability.
Key messages: • Colorectal cancer screening in Portugal is critically under-implemented in volume and quality, with significant follow-up losses leading to predominantly late-stage diagnoses.
• Improving screening requires aligned payment incentives, quality metrics, decentralised outreach and operational monitoring to reduce losses and enable long-term health gains.
Related
- Building a PET/CT Program in Sub-Saharan Africa: A Health-System Framework for Financing, Affordability, and Sustainable Implementation
- Evaluation of a colorectal cancer screening program composed of successive waves of different tests: The experience of the French Calvados County
- Twenty-Five Years of Colorectal Cancer Screening in the Czech Republic: National Registry Trends in Program Performance and Cancer Burden
- Interval colorectal cancer risk by haemoglobin concentration in Australia's National Bowel Cancer Screening Program
- Implementation of a Robotic Colorectal Surgery Program: Early Outcomes from a Tertiary Referral Center
BibTeX
@article{diniz2026colorectal,
title = {{Colorectal cancer screening program: no health gains without effective implementation and financing}},
author = {J M Diniz and M O Ourique and M H Almeida and J Perelman},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1083},
url = {https://doi.org/10.1093/eurpub/ckag169.1083},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Colorectal cancer screening program: no health gains without effective implementation and financing
AU - J M Diniz
AU - M O Ourique
AU - M H Almeida
AU - J Perelman
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1083
UR - https://doi.org/10.1093/eurpub/ckag169.1083
AB - Introduction: Colorectal cancer (CRC) represents the second highest cancer incidence in Portugal. A Colorectal Cancer Screening Program (PRCCR) was implemented in 2019 to achieve early diagnosis. Yet, its effective implementation has never been evaluated. Objectives: To evaluate PRCCR implementation at a Local Health Unit (ULS), which groups hospitals and primary care centers under a common structure. We characterize new CRC cases diagnosed between 2019 and 2024, and analyse associated costs of the PRCCR implementation with different scenarios. Methods: Observational, descriptive, retrospective study with cohort analysis. Analysis included 55,338 PRCCR activity records and 245 diagnosed CRC cases. Operational indicator analysis, characterization of new cases and scenario analysis were conducted. Results: Only 37.9% of records showed valid screening results. Of positive tests, 59.2% were referred for colonoscopy and only 31.0% of requested colonoscopies were performed according to the guidelines. Advanced stages (III/IV) represented 71.1% of cases. Scenario analysis demonstrated that increased participation results in growing losses for ULS, due to increased screening implementation costs and treatment of identified cases, inadequately compensated and incentivized in the current financing model. Conclusions: Significant operational failures and misalignment between the incentive model and public health objectives were identified, compromising program effectiveness and sustainability. Key messages: • Colorectal cancer screening in Portugal is critically under-implemented in volume and quality, with significant follow-up losses leading to predominantly late-stage diagnoses. • Improving screening requires aligned payment incentives, quality metrics, decentralised outreach and operational monitoring to reduce losses and enable long-term health gains.
SN - 1101-1262
SN - 1464-360X
ER -