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Multi-disciplinary group of experts clarify need for colorectal cancer screening, leading cause of death


Colorectal cancer is the third leading cause of new cancer diagnoses as well as deaths each year in the United States. Furthermore, Northern Kentucky is part of three regional hotspots in the country with higher than average incidence and death rates from colorectal cancer (lower Mississippi delta, central and western Appalachia, and eastern Virginia/North Carolina). More concerning is the trend that people under the age of 50 are predominately contributing to the rise in incidence each year. Since 1975, colorectal cancer rates have decreased for those over the age of 50 and increased for those under the age of 50.

This alarming trend and age disparity in new diagnoses prompted the United States Preventative Task Force (an independent panel of experts funded by the Department of Health and Human Services), in May 2021, to change the recommendation of beginning screening colonoscopies for the general population from age 50 to age 45, aligning with recommendations from the American Cancer Society. This change also mandates health insurance companies to cover the screening services. Lowering the threshold to begin screening was based on robust data from several institutions that demonstrated >65% reduction in the risk of death from any colorectal cancers.

Oncology Center in Edgewood

Thus, it comes with great surprise and disapproval from the medical community that a recent European-based NordICC trial published in the New England Journal of Medicine reported a mere 18% reduction in the risk of developing colon cancer and no difference in risk of death in participants invited to have colonoscopy screening performed compared to participants who were not invited. It is important to point out that this study had a participation rate of <50% amongst the group invited to have colonoscopy screening, which undoubtedly dilutes the protective effect of the screening tool in the data analysis. On secondary analysis, the risk of developing and dying from colorectal cancer decreased by 31% and 50%, respectively, in participants who actually underwent colonoscopy screening. It is well established that the majority of colon cancers originate from adenomas, a type of polyp with the potential to change over time and become cancer. In the NordICC trial, the adenoma detection rate (a quality indicator – the proportion of an endoscopist’s screening colonoscopies in which one or more adenomas are detected) was subpar, as nearly one-third of endoscopists were below the benchmark 25% (for reference, in the United States the rate is 39%). Lastly, many medical societies suggest three main options for colorectal cancer screening: colonoscopy (considered the gold standard, every 10 years), fecal immunochemical test (every year), or stool DNA test (every 3 years). It is universally agreed upon that the best screening is the one that is participant compliant, performed, and appropriately followed up on (colonoscopy for positive fecal immunochemical or stool DNA test). The NordICC trial did not offer any alternative screening options for participants that chose not to undergo screening colonoscopy. Unfortunately, as a knee-jerk reaction, many mainstream media sources have irresponsibly questioned the benefits of screening in general while negligently leaving out the aforementioned deficiencies of the study, a move that may have harming effects on the health of our communities, including the Northern Kentucky community. As healthcare providers who screen for, diagnose and treat colorectal cancers and its sequelae, the most devastating cases are amongst patients who never had a colonoscopy screening and present emergently with late stages of colorectal cancer, with symptoms such as bleeding, bowel obstruction, perforation from tumor, and liver metastases. The real conclusion from the New England Journal of Medicine article should be: Colorectal cancer screening, particularly colonoscopy screening, saves lives – it is effective if patients are compliant and it is performed and followed up on properly by experts.

One flawed article published in a reputable journal should not refute decades of robust research supporting the benefits of screening. We strongly advocate without any reservations for the public to follow colorectal cancer screening guidelines supported by the American College of Gastroenterology, American Cancer Society, American Society of Colon and Rectal Surgeons, and the American College of Surgeons: for people at average risk* of colorectal cancer, colorectal cancer screening (colonoscopy every 10 years, fecal immunochemical test every year, or stool DNA test every 3 years) should begin at age 45.

People are considered to be at average risk if they do not have:

• A personal history of colorectal cancer or certain types of polyps
• A family history of colorectal cancer
• A personal history of inflammatory bowel disease (Ulcerative colitis or Crohn’s disease)
• A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis or Lynch syndrome
• A personal history of receiving radiation to the abdomen/pelvis to treat a prior cancer

Chike Anusionwu, MD; Samir Vermani, MD; Colleen Darnell, MD; Ramesh Kumar, MD; Brent Xia, MD

Dr. Anusionwu is a gastroenterologist at St. Elizabeth Healthcare.
Dr. Vermani is a gastroenterologist at Tri-State Gastroenterology Associates.
Dr. Darnell is a hematologist and medical oncologist at St. Elizabeth Healthcare.
Dr. Ramesh Kumar is a colorectal surgeon at St. Elizabeth Healthcare.
Dr. Xia is a surgical oncologist at St. Elizabeth Healthcare.


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