Colorectal cancer remains one of the deadliest cancers in Europe, but a new study from Spain offers compelling evidence that a simple, non-invasive screening test can dramatically reduce mortality. Research published in JAMA Network Open shows that the Basque Country's screening programme, based on the faecal immunochemical test (FIT), was associated with a 50% drop in deaths from colorectal cancer among people aged 50 to 69.
Long-term data from 2.2 million people
The study, led by Dr Luis Bujanda of the University of the Basque Country, tracked mortality records from 2004 to 2024 in a population of nearly 2.2 million. Over that period, there were 438,134 deaths from all causes, of which 16,298 were attributed to colorectal cancer. In the screening age group, the mortality rate fell from 39.7 to 19.8 deaths per 100,000 inhabitants—a decrease of 50.1%. Even across the entire population, deaths dropped from 32.8 to 23.1 per 100,000.
The decline began just three years after the programme was introduced in 2009, with a clear turning point in 2012. The researchers estimate that without screening, mortality in the 50-69 age group would have been 46.2% higher. This sustained reduction over more than two decades strengthens the case for organised screening as a public health priority.
How the screening works
The Basque programme offers FIT every two years to men and women aged 50 to 69 who have no symptoms. FIT detects tiny amounts of hidden blood in faeces, which can be an early sign of cancer or precancerous polyps. A positive result leads to a colonoscopy for confirmation. Over the study period, the programme identified 4,892 cases of colorectal cancer, with 70.8% diagnosed at stages I or II—when treatment is more effective and less aggressive.
This approach aligns with broader European efforts to improve early detection. For instance, cancer has become a leading cause of death in Spain, prompting calls for more robust screening across the country. The Basque results could inform policy in other regions, especially as the EU's Beating Cancer Plan encourages member states to expand screening programmes.
Observational but powerful evidence
The authors caution that this is an observational study, so it cannot prove cause and effect with the certainty of a randomised trial. However, the scale of the mortality reduction and its persistence over 21 years make a strong case for FIT-based screening. Dr Bujanda and his team argue that the findings support the long-term benefits of organised screening as a key strategy to combat colorectal cancer.
Colorectal cancer is one of the most common tumours in Europe and a leading cause of cancer death worldwide. Early detection not only improves survival but also allows removal of polyps before they become malignant. The Basque Country's experience offers a model that could save thousands of lives if adopted more widely across the continent.
As European health systems grapple with ageing populations and rising cancer rates, this study provides concrete evidence that investment in screening pays off. The challenge now is to ensure that such programmes are accessible to all who need them, regardless of where they live in Europe.
