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It is insidious – it develops silently for up to 10 years. It is dangerous – one million people in the world die every year because of it! It is on the offensive – forecasts indicate that the number of colon cancer cases will increase. Fortunately, we are not defenseless – colorectal cancer can be “turned off”. The «off» button is a healthy lifestyle and screening tests …
19 thousand Poles
Colorectal cancer is classified as a so-called “Silent killers”, that is, diseases that do not make themselves known for years. Unfortunately, it is also one of the most common cancers. According to the International Agency for Research on Cancer (IARC), operating within the structures of the World Health Organization (WHO), it is the third most common type of cancer in the world and the second most common cause of death from malignant neoplasms. Each year, nearly a million people die because of it!
The outlook for the future is pessimistic. Based on the trend analysis, it is estimated that in 2020-2040 there will be a global increase in colorectal cancer incidence – the number of new cases will exceed 3 million per year. As a consequence, the death rate due to it will reach approximately 1,6 million deaths annually. The projected growth mainly applies to countries with a high human development index, which is associated with risk factors.
In Poland, colorectal cancer is the second most common malignant neoplasm in women and the third in men. Nastazja Dagny Pilonis, MD, PhD from the Department of Oncological Gastroenterology at the National Institute of Oncology – National Research Institute emphasizes that now, every day about 50 inhabitants of our country hear the diagnosis: it is colorectal cancer, and about 30 people lose their lives because of it . Annually, this means approx. 19 thousand. new cases and approx. 12 thousand. deaths.
According to experts, colon cancer does not come from “space”. It is assumed that 60-70 percent. all cases of disease could have been avoided if …
Lifestyle matters
So far, many risk factors for the development of colorectal cancer are known. We can control some of them, others we cannot. For the latter, the so-called Primarily age is non-modifiable factors.
Colorectal cancer is primarily a disease whose main risk factor is age. Therefore, after the age of 50 the risk of developing the disease increases significantly, and men are more often affected. Most cases are recorded in people over 75 years of age. The risk of developing the disease in men is 1,5 times higher than the risk in women. Family burdens also play an important role when cancer was present in parents or siblings. There is also a group of people with inflammatory bowel diseases or certain genetic syndromes that predispose them to disease, explains Dr. Pilonis.
But this is not the end. There are many more risk factors and what is comforting, we have a real influence on many of them. Science associates an increased risk of developing colorectal cancer primarily with the diet, with a large amount of harmful fats and red meat (pork, beef, mutton). It has been proven that people who consume red meat daily are three times more likely to develop colorectal cancer than people who eat it sporadically or not at all. Especially if the meat is roasted and grilled.
Other environmental factors include obesity, low physical activity, smoking and alcohol abuse, regardless of its type. Doctors emphasize that under the “alcohol abuse” approach is not only drinking large amounts of alcohol or getting drunk, but also drinking alcohol in small amounts, but regularly. The more that, as it has been proven, there is no safe dose of alcohol, each of them has adverse effects and can be carcinogenic. It is also worth remembering that alcohol and cigarettes harm you twice. There is talk of a mutual, stronger carcinogenic effect of these stimulants than for each of them separately.
Prevention “turns off” cancer
Fortunately, we are not defenseless against colon cancer. Our weapon is primary and secondary prevention. The first is primarily a healthy lifestyle.
The risk of falling ill is reduced by a balanced diet rich in natural fiber, fruit and vegetables. We should avoid highly processed products, red meat, excess alcohol. Eliminating smoking is also crucial. Physical activity should accompany us most days a week. It is important to regularly take up physical activity – intense, but appropriately selected for our age and health condition – emphasizes Dr. Nastazja Pilonis.
Screening to detect and treat adenomas and to detect cancer in the early stages that can be treated is essential in secondary prevention. The two most commonly used methods are fecal occult blood testing (FIT) and colonoscopy. Although the name of the latter sounds “cosmic”, it is the standard for detecting polyps, precancerous lesions and neoplasms.
The screening colonoscopy we have performed as part of screening for the past twenty years has been documented to reduce the incidence and mortality of colon cancer. This is a great procedure when it comes to diagnostic possibilities because the endoscope can be inserted into the entire colon and its entire surface can be seen from the inside. And most importantly, remove precancerous lesions or early cancers that qualify for endoscopic treatment at the same time. In this way, we can cure early cancer or remove lesions from which it may develop in the future. For this reason, colonoscopy seems to be a very attractive screening tool, comments Dr. Nastazja Pilonis.
Unfortunately, experts have been pointing out for years that many myths have arisen around colonoscopy, which often stop us from investigating. It is enough to look at the statistics – in Poland, only approx. 17% of people report for colonoscopic examinations as part of screening for colorectal cancer. patients who qualify for them, while in the United States it is 40% and in Belgium as much as 60%. [1]. Moreover, during the last two years of the COVID-19 pandemic, the already low enrollment of Poles for screening tests has dropped drastically. In the first three quarters of 2020, 118 colonoscopies were performed, while in the corresponding period of 257 – 2019. This is a 205% decrease. [214]
The most common reasons that stop us from having a colonoscopy are fear of pain, the need to prepare for the examination and the shame of examining the colon [3], and our body should never be ashamed … Especially since our health is at stake – early diagnosis colorectal cancer gives almost 100 percent. chances of recovery.
And while colonoscopy is a life-saving study, like any other examination, it has advantages and disadvantages.
First of all, it is an invasive procedure that lasts about 20-30 minutes, and also requires a long process of cleaning the intestine with pharmacological agents. In addition, it is often necessary to undergo general anesthesia with the participation of an anesthesiologist, which generates staffing needs, because apart from the doctor and endoscopic nurse, we also need a specialist to anesthetize the patient. Anesthesia increases the risk of complications, and the colonoscopy itself, along with benefits, may also bring complications. The most serious of these are bleeding when removing the lesions or perforation, i.e. damage to the intestinal wall. This sometimes requires surgical intervention, bowelectomy, hospitalization. We can, therefore, imagine that by encouraging healthy people to screening and sending them invitations for voluntary colonoscopy, we must ensure the highest possible quality of this test. The risk of loss versus profits has a slightly different balance. This is not a person with symptoms, referred for diagnosis by a doctor, and the procedure itself requires a lot of attention from us so as not to spoil this health – explains the expert.
Simple, cheap and non-invasive
As Dr. Nastazja Pilonis explains, an alternative to colonoscopy is introduced in many European countries, as well as in Japan and Australia, a program based on the immunochemical fecal occult blood test – FIT. It is simple, cheap, non-invasive and not burdensome. Additionally, it can be done in the comfort of your own toilet.
The FIT test is used to catch people who have occult blood in their feces, i.e. are at high risk of colorectal cancer. Our task is to extract these approximately 10 percent. FIT-positive patients out of the millions of people who are the screening target, and provide them with an invasive diagnostic procedure that is colonoscopy. And while the FIT test is relatively new, large observational studies involving millions of people around the world show that FIT screening reduces mortality from colon cancer. There is no indication that this is a less effective method than colonoscopy. In Poland, we conducted a randomized public health study as part of the screening program. We did not create any artificial conditions, but implemented the option of invitations to screening tests, including the fecal occult blood test, in the existing screening system. In the beginning, we did not want to confront patients directly with the choice of test or colonoscopy, but we wanted to see if those who refused colonoscopy would agree to a fecal occult blood test. We took 12 thousand. people, we divided them into three groups. We offered the first colonoscopy, the second we sent an invitation to choose a fecal occult blood test and a colonoscopy, and the third was offered a colonoscopy first, and we sent an invitation to a fecal occult blood test to those who did not come for it after 6 weeks. We wanted to see if people who refuse colonoscopy will decide to take the FIT test. In both these groups, the increase in reporting was approx. 70%. relative to the colonoscopy itself. Through a large study in real clinical practice, we have shown that we can increase screening reporting in this way, explains Dr. Pilonis.
Screening tests for colorectal cancer should be remembered by everyone over the age of 50.
The general population should be tested by means of an immunochemical fecal occult blood test. If this test is positive, a colonoscopy is required. Due to the higher risk of developing the disease, colonoscopy should be the first-choice test in people with positive family history of colorectal cancer, adds Dr. Pilonis.