at an early stage and before symptoms begin.
Despite colorectal cancer screening
programmes attaining an established presence
across different parts of Europe, many countries
are yet to transition to the most effective and
accurate screening methods. Presently, a number
of European countries are still using the faecal
occult blood test (gFOBT). The test relies on three
samples that are tested for simple oxidation
which can be compromised by the influence
of dietary haemoglobin, leading to a number of
false positives. The recently introduced faecal
immunochemical test (FIT) is more advanced than
the traditional gFOBT method. It is easier to
perform, as it requires only a single stool sample
to check for the presence of blood and has a
simple collection device. Studies have revealed
the increased sensitivity of FIT, resulting in
increased cancer detection. FIT has also been
viewed as a more acceptable test by members
of the public due to the ease of collection. 3 This
method has also been demonstrated to have an
increased participation uptake, and is therefore
a more desirable alternative to the gFOBT
method. In The Netherlands, for example, the
participation rate for FIT was 12% higher than
that for gFOBT. 4 In a FIT-based screening program,
colorectal cancers can be detected at an earlier
stage than through symptoms. All FIT-positive
participants are advised to undergo a
colonoscopy, during which these cancers, as well
as potentially cancerous polyps, will be identified.
After diagnosis the optimal treatment-strategy
The public’s participation
in screening programmes
plays a crucial role in the
success of early detection
will be chosen, of which one is endoscopic removal.
An enhanced understanding of the genetic and
epigenetic changes that are behind the formation
of CRC aims to identify molecular markers for
accurate and non-invasive screening tests. The
addition of molecular markers to the FIT method
could optimise screening accuracy in the future.
In the struggle to combat colorectal cancer,
novel and effective treatments are urgently
required. The surgical resection of tumours
currently represents the best strategy to improve
patient survival rates, however patients still have
a high risk of developing metastases. Additionally,
chemotherapy is not optimally beneficial for all
patients who are diagnosed with advanced
colorectal cancer due to factors like poor efficacy,
drug resistance and severe side effects. 5 In recent
years it has become clear that not all colorectal
cancers are the same, and that the molecular
characteristics of the tumours should be taken
into account. Molecular differences mean that
a ‘one-size-fits-all’ approach to treatment is not
optimal, leading to an increased interest in
a personalised method of treatment. 6 Personalised
colorectal cancer treatment utilises information
about a person’s genes, proteins and environment
to prevent, diagnose and treat the disease. The
ability to use molecular screening to characterise
tumours and target patients who are likely to
benefit from personalised treatment, holds great
potential for positive patient outcomes. Further
research into this mode of tailored treatment
could have a transformative effect on the
concerning upward trend of colorectal cancer
treatment modalities and reduced mortality rates.
Aligning with the move towards more
personalised forms of treatment, recent
developments in artificial intelligence (AI) may
also aid the detection and treatment of tumours.
The advent of AI represents an exciting forefront
in cancer prevention. An endoscopic system
powered by AI has been shown to automatically
identify colorectal adenomas and early cancers
during colonoscopy. The computer-aided
diagnostic system might also use endoscopic,
or a more detailed endocytoscopic imaging to
analyse the polyp, comparing it to other images,
allowing prediction of lesion pathology in less
than a second. 7 The use of AI holds the possibility
of aiding the early identification of potential
cancerous adenomas, helping to reduce the
incidence and mortality of colorectal cancer.
The early detection of colorectal cancer or
potentially cancerous polyps is the most vital
action in reducing colorectal cancer incidence
and mortality. However, a healthy lifestyle can
also act as an integral measure. Alarming figures
have shown that European colorectal cancer rates
in young adults is increasing by 6% per year,
which has been linked to poor diets, sedentary
lifestyles and obesity, with over half of he EU
population being considered overweight. 8,9 The
promotion of healthy lifestyles, reduced alcohol
consumption and a reduction of the European
population’s meat consumption should become
a strong focus of European policy. An enhanced
public understanding of healthy lifestyle options
is an essential measure in mitigating the threat
of colorectal cancer.
The public’s participation in screening
programmes also plays a crucial role in the
success of early detection. Responding to
invitations and completing the at-home tests that
are available across many parts of Europe could
greatly reduce the incidence and mortality rates
that are attributable to colorectal cancer. Health
professionals can also act as proactive figures in
prevention and early detection. Research has
suggested that the lack of colorectal cancer
screening recommendations made by a doctor is
a key barrier to screening uptake. 10 As one of the
most accessible authorities on health matters to
the general public, healthcare professionals
should be broaching the subject of screening
with eligible adults and extolling the benefits
of colorectal cancer screening. The education
of members of the public about the advantageous
aspects of colorectal cancer screening by trusted
healthcare professionals will also help expel the
negative connotations associated with the
screening process. The initial gFOBT or FIT
screening methods are largely painless and
various initiatives are being undertaken across
Europe to improve the quality of colonoscopies
and reduce its burden. In order to improve
detection rates, colorectal cancer screening must
become a normative and essential aspect of
4
HHE 2019 | hospitalhealthcare.com