AMSTERDAM—Screening men and women for colorectal cancer with either fecal occult blood testing (FOBT) or endoscopy markedly lowered the disease's incidence and mortality in a study of screening patterns in 11 European countries over the last 20 years, according to data reported here at the European Cancer Congress by researchers from France, Australia, Italy, and Belgium (Abstract 1405, accessible via http://eccamsterdam2013.ecco-org.eu/Scientific-Programme/Abstract-search.aspx#).
Professor Philippe Autier, MD, MPH, PhD, Vice President of Population Research at the International Prevention Research Institute in Lyon, France, said the results were very clear because the different European countries have such diverging policies on colorectal cancer screening that researchers were able to compare death rates in countries that had effective screening activities with those that did not: “In Western Europe—including France, Belgium, and Germany—you have practically a halving of colorectal cancer in the last 20 years, whereas in central Europe you have practically a doubling of colorectal cancer mortality.”
Included in the study were people older than 50 who underwent screening from 1989 to 2010, which were then compared with the World Health Organization-documented changes in colorectal cancer mortality from the Survey of Health, Aging, and Retirement in Europe (SHARE) project. Having had one or more endoscopic examination of the large bowel over the last 10 years was found to be highly protective, accounting overall for three quarters of the decrease in colorectal cancer mortality.
“The more you had screening, the greater the decrease in colorectal cancer mortality,” Autier said. “The correlation was very high: You cannot escape from the conclusion that screening is making a huge difference in terms of decreasing the risk of dying one day or another from colorectal cancer.”
According to the results, 35 percent of the population in Austria had an endoscopic examination (and 61 percent had FOBT) during the study period, and deaths for colorectal cancer dropped by 39 percent in men and 47 percent in women. This contrasted with the results in Greece, which had an endoscopy rate of only eight percent—where colorectal cancer death rates increased by 30 percent for men and two percent for women, which he said could be due to the departure in recent years from the protective “Mediterranean Diet.”
Autier said he was convinced that great strides forward could be made by greater commitment to bowel cancer screening: “We could cut colorectal cancer mortality as well as incidence—never forget that screening can prevent the occurrence of cancer—and therefore we have the conviction that if we could generalize screening for bowel cancer we could certainly reduce, by probably 50 percent, the burden of that cancer.”
National health care services should put more effort into organizing screening programs based on fecal occult blood testing or endoscopy and in motivating the public to use them, he said. “If two-thirds of eligible people in each country had screening, we believe that we could see a considerable reduction in colorectal cancer mortality in a minimum of 10 years.”
Commenting on the results, Cornelis van de Velde, MD, PhD, Professor of Surgery at Leiden University, pointed to the major differences between the European countries: “It is very disappointing that there are so many differences in outcome due to limitations in the use of screening.” He said he wanted to see more pressure on health services to organize screening programs and to harmonize colorectal cancer screening in Europe so that every future patient could get the best chance of early detection.
Also agreeing, Professor Eric Van Cutsem, MD, PhD, from the University Hospitals Leuven in Belgium, said, “These interesting data underline the utility of systematic colorectal cancer screening, as currently recommended by the European Council.”
Listen on the iPad edition of this issue as Professor Autier elaborates on the study's findings, showing that changes in colorectal cancer mortality are correlated with the level of screening uptake, providing a strong rationale for national bowel cancer screening programs.
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