healthcare
Getting behind a cure for colorectal cancer
Dr Marlys CORBEX
stand upto colorectal cancer
Technical Officer, WHO Europe
Persisting gaps and missed opportunities Improving early diagnosis of symptomatic cancer patients is often overlooked, perhaps because governments focus their efforts on screening. Dr Marilys Corbex, Technical officer, WHO regional office for Europe, says this is a missed opportunity because improving early diagnosis can significantly decrease mortality and improve survival
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olorectal cancer is among the most common cancers worldwide with about 1 million new cases each year. In the European Union, with about 360,000 new cases per year, colorectal cancer is the second most frequent cancer and cause of cancer deaths after lung cancer. The number of cases is expected to increase, reaching an estimated 417,600 new cases by 2025. (1) Incidence varies considerably across European countries from 10 new cases per 100,000 inhabitants in Albania to 86/100,000 in Denmark and 85/100,000 in Hungary. These variations are mainly the results of difference in life style and age demographics of the populations. Once affected, the probability of dying from colorectal cancer also differs widely between countries; in Greece or Latvia it is around 60% compared to 30% in Iceland or Switzerland. (1) What are the risk factors for colorectal cancer? The risk of developing colorectal cancer increases markedly with age: about 8 out of 10 people diagnosed with colorectal cancer in the EU are more than 60 years old. (1) Factors that increase the risk of developing colorectal cancer include: consumption of alcohol, tobacco use, obesity or being overweight, and diets rich in fat and processed meat. Conversely, diets rich in fibres, fruit and vegetable, as well as exercise decrease colorectal cancer risk. (2) www.governmentgazette.eu | 62
Chronic inflammatory conditions of the colon such as ulcerative colitis or Crohn’s disease can increase the risk of colorectal cancer. Also, having a parent or sibling with colorectal cancer increases a person’s risk of developing cancer, particularly if they were diagnosed at a young age. Some genetic colorectal syndromes considerably increase the risk of developing cancer but they are rare and account for less than 5% of colorectal cancers cases. (2)
Improving early diagnosis of symptomatic cancer patients is often overlooked, partly because governments focus their efforts on screening. This is a missed opportunity because improving early diagnosis is a low cost activity which can significantly decrease mortality and improve survival, especially in countries where a large proportion of patients are diagnosed at a late stage. WHO has published in February 2017 a Guide to Cancer Early Diagnosis. (4)
How to ensure early detection? To ensure early detection of colorectal cancer, two types of programmes can be implemented: early diagnosis and screening programmes. Early diagnosis focuses on identifying symptomatic patients and treating them as early as possible, while screening consists of testing healthy individuals to identify those having cancers before any symptoms appear. (3) Early diagnosis programmes For many patients in the EU - even in the richest countries - early diagnosis is not a given: it can take many weeks or even months before a patient who has presented with suspicious symptoms at primary health care level is effectively diagnosed and treated for his/her cancer. This can be due to various causes: poor referral processes, suboptimal training of health staff, long waiting times and/ or poor access to diagnosis and treatment, as well as limited public knowledge about symptoms.
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Screening programmes
Improving early diagnosis is a low cost activity which can significantly decrease mortality and improve survival, especially in countries where a large proportion of patients are diagnosed at a late stage.
Several EU countries are currently implementing colorectal cancer screening programs. Methods for colorectal cancer screening include faecal occult blood test (FOBT), flexible sigmoidoscopy and colonoscopy. • FOBT detects small amounts of blood in stool, which can indicate colorectal cancer before any symptoms develop. Randomised controlled trials suggest that screening with this method reduce colorectal cancer mortality by up to 25%. • Flexible sigmoidoscopy enables visualisation of the lower portion of the colon and rectum. Randomised controlled trials