Colorectal cancer: a spreading but preventable disease

Abstract

A sharp increase in incidence and mortality for Colorectal Cancer (CRC) is characterizing the “non Western” nations of the Mediterranean area, but also the Far East, Australia and the Central/South America. Western style behaviours (diet, reduced physical exercise, etc) are considered as the underlying cause of such epidemiological patterns. Primary prevention may be achieved observing a low-fat diet, high in fruit and vegetables. In general, a low calories intake and regular physical exercise seem to be responsible for the protective effect. Secondary prevention of CRC may be achieved by screening which is today the most effective action to curb mortality and extend survival, but is implemented gradually only in more affluent nations. Some screening tests, well known to gastroenterologists worldwide, may save lives by detecting colorectal cancer in its earliest, most curable stage, and by detecting and removing polyps. The tests available are: 1) Faecal Occult Blood Tests (FOBT), widely employed and easily acceptable by healthy subjects; 2) Colonoscopy (TC), allowing also the removal of adenomas and the procedure of choice in high risk subjects; 3) Computed Tomographic Colonoscopy (CTC), emerging as a possible and effective screening tool but with cost-effectiveness and sensitivity for minor or flat lesions to be further explored; 4) DNA in stools: being colorectal carcinogenesis the result of a series of acquired genetic alterations that occur in colonic epithelial cells, is now possible to recover analyzable DNA from the stools and test for the presence of these genetic alterations; costs and effectiveness are still under evaluation. In conclusion, screening is the most effective action for the control of CRC, but public health initiatives are scarce and suffer from the lack of awareness and more urgent priorities.