A recently published European study that minimizes the benefits of colonoscopy to prevent colorectal cancer diagnoses and deaths has several limitations and must not deter anyone 45 and older from being screened, experts from the Mays Cancer Center at UT Health San Antonio said today in a consensus statement. The Mays Cancer Center is South Texas’ only National Cancer Institute-Designated Cancer Center.
The Mays Cancer Center/UT Health San Antonio Joint Cancer Prevention and Screening Committee, which includes Mays Cancer Center clinicians and researchers along with faculty experts in primary care and related disciplines, strongly recommends that South Texans “continue to follow the established guidelines to undergo colorectal cancer screening, including colonoscopy, beginning at age 45.”
“Colorectal cancer, like many cancers, can be treated if caught early. The best way to treat it is to prevent it,” said Alicia Logue, MD, a fellowship-trained colorectal surgery specialist at the Mays Cancer Center. “Finding growths called polyps in the colon or rectum and removing them can prevent colorectal cancer and the suffering it causes. Colonoscopy enables us to locate and remove these small growths early.”
Logue, who joined the Mays Cancer Center in 2008, is associate professor of medicine in the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio.
“Primary care physicians at UT Health San Antonio will continue to follow U.S. Preventive Services Task Force recommendations on colorectal cancer screening,” said Ramon Cancino, MD, associate professor of family and community medicine in the Long School of Medicine and co-chair of the Cancer Prevention and Screening Committee. “We will help our patients to put the study findings into proper context.”
The Nordic-European Initiative on Colorectal Cancer (NordICC), published Oct. 9 in The New England Journal of Medicine, compared colorectal cancer detection and deaths in nearly 85,000 men and women ages 55 to 64 in Poland, Norway and Sweden. Study participants were randomly invited to undergo a colonoscopy between 2009 and 2014 or were followed without having the procedure.
Ten years of monitoring outcomes indicated that participants who had colonoscopies were 18% less likely to be diagnosed with colorectal cancer than unscreened participants. The risk of death in those screened was also reduced, but the decrease was not statistically significant, the researchers reported.
The Mays Cancer Center/UT Health San Antonio committee agreed with a statement by the Cancer Prevention and Research Institute of Texas (CPRIT) that noted:
- Of the 28,000 study participants who were invited to have a colonoscopy, fewer than 12,000 did so. This is a low participation rate compared to other trials.
- Benefits of completing a colonoscopy take time to be realized. NordICC study participants underwent colonoscopy only once, and follow-up data were unclear.
- Colorectal cancers can be slow to develop. Many patients in the study were followed for fewer than 10 years.
The committee added several more points, including:
- The study age range was 55 to 64. The findings don’t address colorectal cancer detection and survival among younger or older patients.
- Colorectal cancer biology differs among ethnic groups. Hispanics in South Texas have different underlying risk factors for the disease than the Northern European participants in the NordICC study.
“Though not addressed in the NordICC study, the high personal, psychological and financial costs of cancer treatment, especially when found and treated at later rather than earlier stages, should not be overlooked from a cost-effectiveness and value-based care perspective,” Cancino, director of the Primary Care Center within the UT Health Physicians practice, said.
He thanked Mays Cancer Center physicians Gail Tomlinson, MD, PhD, co-chair of the committee; Sukeshi Arora, MD, member; Glenn Gross, MD, member; Alicia Logue, MD, member, and Ruben Mesa, MD, executive director of the Mays Cancer Center, for contributing to the consensus statement.
The U.S. Preventive Services Task Force and the American Cancer Society continue to recommend that adults undergo colorectal cancer screening, including colonoscopy, beginning at age 45. In addition, healthy lifestyle choices related to diet, exercise, sun safety, tobacco, and alcohol use can help lower cancer risk.
“Colonoscopy is the most effective test to prevent, diagnose and reduce the incidence of colorectal cancer,” Logue said. “Patients may also consider alternatives to screening colonoscopy after discussing it with their primary care physician. Options include flexible sigmoidoscopy and CT colonography (“virtual colonoscopy”), as well as stool-based tests such as the fecal immunochemical test (FIT), fecal occult blood test and fecal DNA tests.”
More than 150,000 Americans will be diagnosed with colorectal cancer in 2022 and more than 52,000 will die of it this year, according to the National Cancer Institute.