Numerous attempts have been made at developing adenoma detection instruments, the oldest being the fecal occult blood test (FOBT). In this test the subject takes a sample of its stool, smears this on a test strip and sends the strip to a laboratory where the stool sample is analyzed for its blood content. This is then taken as a confirmation that there is a bleeding event somewhere in the colon. Since all colon cancers tend to seep blood and many adenomas do so as well, the subject is then indicated for a full colonoscopy to identify and extract the cause of bleeding. FOBTs however are not very precise because the most frequent bleeding events come from hemorrhoids and because many adenomas do not bleed.
In Europe it is a standard procedure in many countries that each subject, upon its 50th birthday, gets sent a FOBT test and is urged to send in a stool sample for analysis. If this proves positive the subject is then referred to a colonoscopy. In the USA the use of FOBT tests is less frequent with subjects in the great majority opting for a direct colonoscopy.
The increased frequency of preventive measures has had a strong impact on colon cancer incidence. In 2000 it was estimated that by 2015 approximately 200’000 subjects would be diagnosed with colon cancer. The most recent estimates made by the US authorities now project cancer diagnoses to be down to 134’490 subjects, a substantial decrease only due to increased colonoscopies. In Europe it is estimated 447’000 persons are diagnosed with colon cancer in 2016.
Currently it is estimated that around 15 million colonoscopies are performed annually in the USA, 17 million in the EU and 60 million in the rest of the world. Given the enormous savings caused by the prevention of colon cancer, it is expected that the colonoscopy market will continue to expand strongly all the more since the 50 year and above age group in the USA and Europe is steadily growing and since the middle class in the developing countries is expected to grow substantially.