AMSTERDAM – Countries with widespread colorectal cancer screening are reaping the benefits of their efforts.
An analysis involving 11 European countries found that the greater the proportion of people screened, the bigger the reduction in colorectal cancer (CRC) deaths for both males and females. Countries with low rates of CRC screening had sluggish declines or actual increases in CRC mortality over the 22-year study period, despite having health care services that were comparable to those of high-screening countries, Dr. Philippe Autier reported at the European Cancer Congress 2013.
For example, CRC deaths fell 39% for men and 47% for women in Austria, where 35% of men and 36% of women aged 50 years or more had an endoscopic examination of the large bowel between 1989 and 2010. In contrast, CRC mortality rose by 30% among men and 2% among women in Greece, where endoscopic examinations reached a low of 8% for both sexes over the same period.
Patrice Wendling/IMNG Medical Media
Dr. Philippe Autier
Fecal occult blood test screening over the past 10 years reached a high of 61% for both sexes in Austria versus a low of 4% in the Netherlands. CRC mortality declined by 4% for men and 10% for women in the Netherlands, the lowest declines posted in the study (Ab. 1405).
A history of at least one endoscopic exam explained 73% of the decrease in CRC mortality in men and 82% of the decrease in women, according to Dr. Autier, research director at the International Prevention Research Institute, Lyon, France.
The investigators based their calculations on CRC screening data collected from participants, aged 50 years or more, in the Survey of Health, Aging, and Retirement in Europe (SHARE) project and on data from the World Health Organization mortality database. The team is planning to collect additional data from Europe, and to gather data from the United States, Canada, and Australia.
CRC screening is more cost-effective than either mammography or prostate-specific antigen (PSA) testing, and the risk of overdiagnosis is very low since endoscopy involves systematic removal of polyps or precancerous lesions, Dr. Autier said at a press briefing.
Prof. Jack Cuzick, with the Centre for Cancer Prevention at Queen Mary, University of London, commented that "the real challenge now is to get this information out into the public enough and to find ways to get compliance rates up, because this is probably the single most important screening modality we have in terms of a highly effective screening test that actually has an impact on a major cancer."
Future research will also need to determine whether countries can actually build preventive activities into their CRC screening programs.
"We do know how to prevent about 30% of colorectal cancer incidence and mortality by something as simple as a daily aspirin," Prof. Cuzick said. "Whether we should focus that on people just at high risk, because they have an adenoma or other factors, or not, is important."
European CanCer Organisation President Prof. Cornelis van de Velde said in a statement that "it is very disappointing that there are so many differences in outcome due to limitations in the use of screening. People over 50 should be informed of the availability of the test, and pressure should be put on national health services to put more effort into organizing screening programs."
As for whether one screening test should be advocated over another, he told reporters that the American Cancer Society has the right message: "Do something, you have the choice."
Dr. Autier reported having no financial disclosures.
