[P] Why is colorectal cancer screening important? What the statistics say about the effectiveness of treatment

Colorectal cancer is the most frequently diagnosed type of cancer in Romania, with over 13,500 new cases registered every year and is the second cause of mortality among cancer patients, with over 7,000 deaths annually. However, it is a cancer that can be prevented and treated if detected in time.

International and national organizations such as the World Health Organization and the National Institute of Public Health emphasize the importance of screening in the prevention of colorectal cancer, increasing the chances of effective treatment by diagnosing the disease in its early stages, when the success rate can reach 90%.

What is colorectal cancer screening?

Screening means testing before symptoms appear. In the case of colon and rectal cancer, this is essential because the disease progresses silently in the early stages. Even when symptoms do occur, they can easily be mistaken for minor digestive problems, which often leads to delaying a visit to the doctor. Delay in diagnosis and treatment allows the disease to progress, reducing the chances of survival.

Screening for this type of cancer involves:

• performing a simple test (FIT, FOBT), fast and non-invasive, for the detection of traces of blood in faeces or a more complex, but still fast and non-invasive, FIT-DNA that detects traces of blood and DNA changes;
• performing a colonoscopy that helps both to detect and remove precancerous lesions and to identify cancer in its early stages.

It is important not to avoid colonoscopy out of fear or shame. It is the most valuable tool for the prevention and diagnosis of colorectal cancer and, contrary to popular belief, it is not an investigation that involves discomfort or pain, as it is performed under anesthesia.

At what age should you start testing?

The general recommendations are that screening for colorectal cancer should be carried out from the age of 50, because after this age most cases are detected. But when there are risk factors, testing should start at age 45.

Risk factors include:

• family history of colorectal cancer (first-degree relatives with this diagnosis) or family adenomatous polyposis;
• the presence of gastrointestinal diseases that predispose to colorectal cancer – Lynch syndrome, chronic ulcerative colitis, Crohn's disease;
• high-fat diet;
• sedentarism;
• obesity;
• smoking;
• constant/excessive alcohol consumption.

Which doctor do you go to for screening?

First-line screening tests, such as FIT, FOBT, FIT-DNA, may be recommended by your family doctor or internist if you are of age for screening and/or have risk factors for colorectal cancer.

However, you can get a referral for a colonoscopy from the gastroenterology specialist, if he considers it necessary, after evaluating the risk factors, during the consultation. It is important to know that this investigation is not conditional on a positive result in the first-line tests, but can be recommended in addition to them. Colonoscopy can reveal additional abnormalities to those detected by the tests mentioned above. You can learn more about these tests by going to aifaceorice.roa platform dedicated to informing about the importance of screening for colorectal cancer.

When symptoms appear, it becomes mandatory to see a doctor

It is ideal not to wait for the symptoms to appear, but if you have missed the screening and are experiencing pronounced and persistent abdominal discomfort (bloating, cramps, pain, feeling too full), frequent diarrhea and/or constipation, rectal bleeding or blood in the stool, nausea, vomiting, pronounced fatigue and unexplained weight loss, presentation to the gastroenterologist is mandatory

Bibliography:
The Global Cancer Observatory. Romania, 2022
INSP. Colorectal cancer screening, from pilot projects to national program
INSP, Cancer Screening
INSP. Cancer Country Profile. 2023
World Health Organisation. Colorectal cancer
US National Institutes of Health. Signs of colorectal cancer
US Centers for Disease Control and Prevention, Screening for Colorectal Cancer
US National Institutes of Health. Colonoscopy
US National Institutes of Health. Colorectal Cancer: An Overview
US National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program; Cancer Stat Facts: Colorectal Cancer