Colorectal cancer is currently the most frequent cancer and the most frequent cause of cancer induced deaths in man in Europe. Demographic trend indicate a continuing increase in this substantial public health problem. Systematic early detection through screening, effective diagnostic pathways and optimal treatment have the ability to substantially lower current colorectal cancer mortality rates and reduce the burden of this disease in the population.

In order that these benefits may be obtained, high quality services are essential. These may be achieved through the underlying basic principles of training, specialisation, volume levels, multidisciplinary team working, the use of set targets and performance indicators and audit. Ethically these principles should be regarded as applying equally to symptomatic diagnostic services and screening.

The editors have maintained focus on screening for colorectal cancer while at the same time supporting the provision of highly effective diagnostic services and the setting up of specialist units for treatment, irrespective of whether a lesion has been diagnosed within a screening programme or not. By so doing we support the resolution of the European Parliament in June 2003 (OJ C 68E, 2004), calling on the EU member states to make the fight against cancer a health policy priority and to develop and implement effective strategies for improved preventive health care encompassing screening, diagnosis and treatment throughout Europe.

The primary aim of colorectal screening programme is to reduce mortality from cancer through early detection. Unnecessary workup of lesions which show clearly benign features should be avoided in order to minimise anxiety and maintain a streamlined cost-effective service.