redOrbit Staff & Wire Reports – Your Universe Online
“Irrefutable” evidence that colorectal cancer (CRC) screening is effective at reducing the disease’s mortality rate should lead healthcare policymakers to shift resources currently devoted to breast and prostate cancer screenings to CRC testing, Belgian epidemiologist Philippe Autier will report this weekend.
Autier, the vice president of population studies at the International Prevention Research Institute in France, will present data about CRC screenings collected as part of the Survey of Health, Ageing, and Retirement in Europe (SHARE) project during the 2013 European Cancer Congress (ECC2013) on Sunday.
During his speech, the professor will argue that colon and bowel cancer screenings such as fecal occult blood tests of FOBT (which tests stool samples for hidden blood) and endoscopy (in which a tiny camera is used to search of pre-cancerous polyps in the large bowel of the patient) have been proven effective, while the evidence that breast and prostate cancer screenings can save lives is less convincing.
Combining SHARE data pertaining to screenings in both men and women over the age of 50 between 1989 and 2010 with information from the World Health Organization (WHO) cause-of-death database, Autier and his colleagues calculated CRC death rates in 11 different European countries.
The information was then related with how widespread screening procedures were, as well as how likely people were to take advantage of such services. In some cases, the screenings were part of national health programs (such as FOBT screening in France and the UK, or both FOBT and endoscopy in Germany and parts of Italy). In others, patients and/or their doctors made the decision to undergo one or both types of CRC screenings.
“We saw quite clearly that the greater proportions of men and women who were screened, the greater the reductions in mortality,” Autier is scheduled to report during his presentation. “Reduced death rates from CRC were not noticeable in countries where screening was low, even though healthcare services in those countries were similar to those in countries where screening was more widespread.”
According to the researchers, 61-percent of all Austrian residents reported having undergone an FOBT screening during the study period. At that same time, the CDC mortality rate decreased by 39-percent among men and 47-percent among women. Conversely, only eight percent of Greek males underwent an endoscopic examination during the study period. During that time, the country reported a 30-percent increase in CRC death rates among men.
Overall, in the 11 European nations studied, 73-percent of the decrease in CRC-related mortality in males and 82-percent in females over a period of 10 years could be attributed to undergoing at least one endoscopic bowel examination over the span of a decade, Autier and his colleagues claim.
“The evidence could not be clearer, and it is therefore very disappointing that national differences in the availability of CRC screening programs are still so pronounced,” according to the professor. “There are signs that CRC screening can reduce the incidence of this cancer as well as mortality from it, in exactly the same way as is happening with cervical cancer screening. We would also like to investigate the cost-effectiveness of CRC screening, since we believe that it has the potential to bring about economic gains associated with averted CRC cases and deaths, and hence to more than pay for its initial cost.”
Autier’s team plans to gather additional information on CRC screening, and are also looking to review data collected from Australia and North America. If two-thirds of eligible people in each country undergo testing, the researchers believe that it could result in “a considerable reduction” in colon and bowel cancer deaths in a minimum of 10 years. They believe that federal healthcare services need to redouble their efforts into making FOBT and endoscopy tests available to citizens, while educating people over the age of 50 about the availability of these screenings.
“There is a clear relationship between randomized trials showing the ability of any type of CRC screening to reduce the risk of death from the disease, data from cancer registries showing declines in the incidence of advanced CRC, and declines in CRC mortality over time,” Autier said. “In breast cancer, there is no such smooth logical sequence between randomized trials and these population statistics. It seems to us that there is now an irrefutable case for devoting some of the resources from breast and prostate cancer screening to the early detection of CRC.”
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