The early diagnosis of colorectal cancer, thirty years later

@varelalaf

Health systems have long-planned population programs for the early detection of certain cancers through diagnostic techniques arising from the clinical setting, such as prostate-specific antigen (PSA), mammograms, ultrasound or the study of faecal occult blood that is the case at hand. This issue is generating confusion in society because one thing is to take care of one's health and the other, quite different, is to undergo medical tests to discover tumours in their early stages. On the other hand, discomforts are also generated among professionals, because it’s not the same to treat patients who seek help for health problems, than to propose extensive tests to the healthy population.

Live more?

Thirty years after starting a randomized clinical trial with 46,551 people 50 to 80 years old in the US Veterans Administration, in which one-third of the participants did not follow any particular program, one third had a faecal occult blood test every two years, and one last third had the test every year, the result, according to the article "Long-Term Mortality after Screening for Colorectal Cancer", showed that while in the first group 295 people died of colorectal cancer, in the second 237 people died and in the third group, only 200 died. Therefore, the relative risk reductions were 24% and 35% respectively. Very significant figures.

The study also shows often disregarded evidence in this type of evaluation, and that is that long-term mortality in older people is very high, which tends to dilute the final results of actions as specific as those of preventive programs for colorectal cancer. The point is that of the 46,551 people studied, after thirty years, 33,020 had died, 70.9% was distributed in almost equal parts among the three groups, which showed a relative risk of dying from any cause that, once adjusted the indicators, it was identical.

People’s perception about quality of life is a very personal issue, but what we know for sure is that the participants of the two intervention groups had more dependence on the health system, more risks of overdiagnoses and more extractions of suspicious polyps. With the figures in hand, we must admit that thanks to therapeutic actions in more early stages, some people survived more colorectal cancer, but this success dissolved in the context of relatively associated high mortality, so it could not be counted in the global calculation.

It’s understandable that with age, we become obsessed with preventing severe diseases and embrace all the preventive proposals that come to us from the health system, but considering the results of the mentioned study, and others of the same style, I think it’s more advisable, and healthy, to simply embrace the life we ​​have left positively, although, at this point, everyone knows what's best for them.

Jordi Varela

Editor