Cardoso R, Guo F, Heisser T, et al. - In view of the substantial differences in colorectal cancer screening programs and uptake across Europe, researchers herein compared changes over time in colorectal cancer incidence, mortality, and stage distribution in relation to colorectal cancer screening implementation in European countries. From 21 European countries, they obtained data from around 3.1 million patients with colorectal cancer diagnosed from 2000 onwards (up to 2016 for most countries), and used these data to determine changes over time in age-standardised colorectal cancer incidence and stage distribution. In countries where high screening coverage and uptake were rapidly achieved (ie, Denmark, the Netherlands, and Slovenia), initial increase was observed in age-standardized incidence rates but then there was a subsequent decrease. Conversely, an increase occurred in colorectal cancer incidence in most countries where there was no large-scale screening program (eg, Bulgaria, Estonia, Norway, and Ukraine), with average annual percentage changes (AAPCs) ranging from 0·3% (95% CI 0·1 to 0·5) to 1·9% (1·2 to 2·6) in men and from 0·6% (0·4 to 0·8) to 1·1% (0·8 to 1·4) in women. Countries with long-standing screening programs exhibited the largest decreases in colorectal cancer mortality. Overall findings suggest divergent trends in colorectal cancer incidence, mortality, and stage distribution across European countries, which seem to be largely due to different levels of colorectal cancer screening implementation.