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Should Pink October Turn Blue?

By Chris Adams, Research Advocate for Fight Colorectal Cancer

alan-npafLast month, you may have noticed the pink jetliners, pink NFL players and pink garbage trucks.  Yes, it was Pink October, also known as National Breast Cancer Awareness Month (NBCAM).  NBCAM is probably the biggest and most successful public awareness campaign in modern US history.  NBCAM’s goal is to increase awareness of the need to screen for breast cancer through mammograms.  Now we are in November and you may have noticed that your colleagues are sporting more facial hair than Mumford and Sons.  Yes, it is Movember or No-shavember or something, the up and coming awareness month for prostate cancer screening and men’s health.

 

At the recent European Cancer Conference in the Netherlands, Professor Philippe Autier, Vice President, Populations Studies at the International Prevention Research Institute in Lyon France, argued there was too much emphasis on mammography and prostate screening at the expense of colorectal screening. Professor Auttier stated that “it seems to us that there is now an irrefutable case for devoting some of the resources from breast and prostate cancer screening to the early detection of CRC.”

 

Professor Autier’s comments were based on a study he presented at the conference.  The study used survey data from a sample of men and women over 50 in 11 European countries over an eleven year period to determine the extent of CRC screening across countries and time. It then compared death rates from CRC in the same countries over the same time period.  The results indicated that increased screening rates for CRC is associated with reduced death rates from colorectal cancer.

 

These results confirm that CRC screening can save lives.  However, why did he make a comment about breast and prostate cancer?

 

There are controversial aspects to screening mammography and PSA tests.  Both tests have a relatively high “false positive” rate.  In other words, the test indicates that a cancer is present when it’s not.  A large study found that if a woman had an annual screening mammogram, she has a 61% chance of have a false positive result over 10 years[1].  A high incidence of false positives associated with a test can lead to a lot of wasted medical spending in terms for follow up tests and a lot of unnecessary concern on the part of the patient.  Worst of all, it may lead to less reliance on the test among those people for whom the test is actually useful.

 

Also, both mammograms and PSA tests detect cancer in very early stages.  While this may seem great, it has been raised as a concern because it is not clear that people found to have such early stages of cancer will ever actually die of the disease, even without treatment.  At the same meetings, Professor Autier’s colleague Dr Mathieu Boniol presented analysis of the impact of general PSA screening for men aged 55 to 69.  While general PSA screening reduces prostate cancer deaths by 10 in 10,000 men screened, it is also associated with increased rates of biopsy with 90 in 10,000 men being hospitalized due to the increase in biopsies and 2 in 10,000 dying from complications associated with the increase in biopsies.  Dr Boniol argued that for this reason there should be lower reliance on PSA as a general screening technique.  A recent Journal of the American Medical Association (JAMA) editorial[2] stated that detection and treatment of very early stage breast cancer (ductal carcinoma in situ) has not led to lower rates of invasive breast cancer.

 

In short, both mammography and PSA have been shown to reduce death due to cancer, but both are controversial because they also lead to greater diagnosis of patients who may not ever die of the disease.  Colorectal cancer screening is a lot less controversial – in fact, the JAMA article referred to CRC screening as a crown jewel.  There are multiple screening tools for colorectal cancer including FOBT, endoscopy, sigmoidoscopy and colonoscopy.  These tools are each different and each has its own advantages and disadvantages.  Colonoscopy is the most expensive; at the same time, it is the only “one stop screening test”.  The other tests may detect polyps or cancer, in which case a colonoscopy is required to fully diagnose the patient.  In addition, colon polyps are routinely removed during colonoscopies, thus preventing future cancers from forming.

 

While the US Preventative Task Force (USPSTF) recommends all women aged 50 to 75 get both colorectal cancer screening and breast cancer screening, many fewer women are up to date with their CRC screening.  And even though the USPSTF recommends against routine PSA tests, many men do them routinely, while neglecting their CRC screening.

 

So the next time you are watching a pink clad linebacker blind side your favourite quarterback, or when you see a Magnum P.I. lookalike in November, think about getting a colonoscopy.

Join the fight

As we approach March 2014, Colorectal Cancer Awareness Month, we need to remember the importance of our unified voices.  The nationally funded screening programs that are making a difference need our support – read more here.  Your voice counts.

 

Join us at the 2014 Call on Congress – Register today. 

Or if you can’t make it, become an eAdvocate.

Help us make colorectal cancer a national priority.

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