Colorectal Cancer: prevention strategies

Colorectal cancer is the third most common cancer among men and the second among women. Most of these cancers develop from adenomatous polyps in a period that can be ten years or more. This long progression offers enough time to adopt preventive strategies with reasonable levels of effectiveness in a context of a mucosa where the presence of polyps is fairly common, despite only some of them evolving toward malignancy.

Colonoscopy is a technique that has been proven effective in reducing mortality from colorectal cancer, but no one can ignore the difficulties of applying this technique extensively, given the low adherence to the calls and the high costs of the program, without forgetting the side effects inherent to the practice of colonoscopy. For this reason I thought it opportune the study lead by Dr. Enrique Quintero (Hospital Universitario de Canarias) and Dr. Antoni Castells (Hospital Clínic Barcelona) which compares, in a prospective clinical trial involving more than 50,000 calls, the practice of a one time colonoscopy with the analysis of a stool sample (with immunochemical test) every two years. The work has an expected 10-year follow-up, and aims to measure the impact in terms of deaths avoided, and although it is still evolving, New England has published a progress report.

In the following table we can see the first results with no difference between the two techniques in the detection of cancer, but they do exist, however, in detecting adenomatous lesions in favour of colonoscopy:

Despite being initially less effective than colonoscopy, the wider acceptance of the faecal immunochemical test, together with its possibility of repeating it conveniently and inexpensively every two years has positioned it at the forefront of strategies for prevention of colorectal cancer. We are waiting for the long time results in mortality.


Jordi Varela

Editor