What is needed for colorectal cancer screening in Japan

There have been accumulated evidence with colorectal cancer(CRC)screening programs using the fecal occult blood test (FOBT). However, the purpose of CRC mortality reduction has not been attained as are the same with the other cancer screening programs in Japan. Thus the present issue with the CRC screening program is how we could reach the goal. Organized screening(OS), which is the strategy for reducing cancer mortality through screening, should be constructed in Japan for the purpose. Scientific evidence to reduce mortality is the prerequisite of OS. In addition, the second step required is to establish a quality assurance system or the management of the screening program, which can maximize the benefit and minimize the harms from screening. Finally, establishing a call-recall system enabling high participation rate is important. The above change may need an implementation of institutional reform on cancer screening in Japan.