AbstractAimIn 2014, a national colorectal cancer (CRC) screening programme was launched in the Netherlands. It is difficult to assess for the individual patients with CRC whether the oncological benefits of surgery will outweigh the morbidity of the procedure, especially in early lesions. This study compares patient and tumour characteristics between screen‐detected and nonscreen‐detected patients. Also, we present an overview of treatment options and clinical dilemmas when treating patients with early‐stage colorectal disease.MethodBetween January 2014 and December 2016, all patients with nonmalignant polyps or CRC who were referred to the Department of Surgery of the Leiden University Medical Centre in the Netherlands were included. Baseline characteristics, type of treatment and short‐term outcomes of patients with screen‐detected and nonscreen‐detected colorectal tumours were compared.ResultsA total of 426 patients were included, of whom 240 (56.3%) were identified by screening. Nonscreen‐detected patients more often had comorbidity (P = 0.03), the primary tumour was more often located in the rectum (P = 0.001) and there was a higher rate of metastatic disease (P < 0.001). Of 354 surgically treated patients, postoperative adverse events did not significantly differ between the two groups (P = 0.38). Of 46 patients with T1 CRC in the endoscopic resection specimen, 23 underwent surgical resection of whom only 30.4% had residual invasive disease at colectomy.ConclusionDespite differences in comorbidity, stage and surgical outcome of patients with screen‐detected tumours compared to nonscreen‐detected tumours were not significantly different. Considering its limited oncological benefits as well as the rate of adverse events, surgery for nonmalignant polyps and T1 CRC should be considered carefully.