Original article 200Introduction ! Cancer of the colon and rectum (colorectal cancer [CRC]) is one of the most common cancers diagnosed in Western countries and is a major cause of cancer-associated morbidity and mortality [1,2]. In Europe, the annual age-standardized incidence of CRC is 35 and 55 per 100 000 in women and in men respectively [1]. The age distribution of CRC shows a predominance in patients > 50 years with less than 10 % of patients being younger than 50 years [3]. The mean age at diagnosis was found to range from 65 to 71.5 years [4]. CRC is the second major cause of cancer mortality in both women and men. While the survival rate for early-stage cancers is high, the survival rate for those diagnosed with widespread cancer is low. About 75 % of all new cases of CRC occur in asymptomatic individuals with no known predisposing factor for the disease except age (≥ 50 years old; average risk) [5]. The remaining cases occur in individuals with a family history of CRC or adenomatous polyps, or with a family history of hereditary nonpolyposis colorectal cancer (HNPCC), or with familial adenomatous polyposis (FAP) or attenuated FAP. Screening, which refers to the search for colorectal lesions in asymptomatic patients with no personal history of CRC or adenomas, appears to be the best option available to reduce CRC morbidity and mortality by early detection of CRC in individuals ≥ 50 years old. However, there is debate about the best screening method and about whether colonoscopy should be recommended for CRC screening. In April 2008, a multidisciplinary European expert panel was convened in Montreux, Switzerland, to discuss and develop criteria for the appropriate use of colonoscopy. This article presents the literature review on screening for CRC in asymptomatic individuals that was provided to Background and study aims: To summarize the published literature on assessment of appropriateness of colonoscopy for screening for colorectal cancer (CRC) in asymptomatic individuals without personal history of CRC or polyps, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. Methods: A systematic search of guidelines, systematic reviews, and primary studies regarding colonoscopy for screening for colorectal cancer was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy in these circumstances. Results: Available evidence for CRC screening comes from small case-controlled studies, with heterogeneous results, and from indirect evidence from randomized controlled trials (RCTs) on fecal occult blood test (FOBT) screening and studies on flexible sigmoidoscopy screening. Most guidelines recommend screening colonos-

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