Skip to main content
SpringerLink
Log in

Colorectal cancer: screening and some notes on the prevention

  • short review
  • Published:
memo - Magazine of European Medical Oncology Aims and scope Submit manuscript

Abstract

At the moment cancer screening is a hot topic which is widely discussed in scientific as well as in popular press. The expected benefits, improvement of prognosis and the reduction of mortality, must be weighed against potential harms, such as the risk of over-diagnosis, false-positive findings, and complications of invasive screening examinations. Screening for breast, cervical, and colorectal cancer has proven to be effective and is therefore recommended by major medical societies and international guidelines. Different tests for colorectal cancer screening are available. Besides established strategies using fecal occult blood test and colonoscopy new and potentially less invasive techniques are on the rise. Our aim is to discuss different strategies for colorectal cancer screening and to present the available screening tests. According to the World Health Organization prevention is the most cost-effective long-term strategy for the fight against cancer. Almost half of all cancer deaths are related to preventable causes. In general, life style modification and some dietary advices can be recommended, but the role of micronutrient supplements remains unclear. There is mounting evidence that some drugs such as nonsteroidal anti-inflammatory drugs, statins, or metformin may have a chemoprotective effect, but is there enough evidence to give general recommendations?

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49:1374–403.

    Article  PubMed  CAS  Google Scholar 

  2. Bundesanstalt Statistik Österreich. Statistik Austria: Dickdarm, Enddarm. Online 2013.

  3. Atkin WS, Edwards R, Kralj-Hans I, Wooldrage K, Hart AR, Northover JMA, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet. 2010;375:1624–33.

    Article  PubMed  Google Scholar 

  4. Kinzler KW, Vogelstein B. The genetic basis of human cancer. 2nd ed. McGraw-Hill Professional; 2002. pp. 583–612.

  5. Patai A V, Molnár B, Tulassay Z, Sipos F. Serrated pathway: alternative route to colorectal cancer. World J Gastroenterol. 2013;19:607–15.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Gondos A, Bray F, Brewster DH, Coebergh JWW, Hakulinen T, Janssen-Heijnen MLG, et al. Recent trends in cancer survival across Europe between 2000 and 2004: a model-based period analysis from 12 cancer registries. Eur J Cancer. 2008;44:1463–75.

    Article  PubMed  CAS  Google Scholar 

  7. Lieberman DA. Clinical practice. Screening for colorectal cancer. N Engl J Med. 2009;361:1179–87.

    Article  PubMed  CAS  Google Scholar 

  8. Allison JE, Sakoda LC, Levin TR, Tucker JP, Tekawa IS, Cuff T, et al. Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics. J Natl Cancer Inst. 2007;99:1462–70.

    Article  PubMed  Google Scholar 

  9. Moayyedi P, Achkar E. Does fecal occult blood testing really reduce mortality? A reanalysis of systematic review data. Am J Gastroenterol. 2006;101:380–4.

    Article  PubMed  Google Scholar 

  10. Brenner H, Tao S. Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy. Eur J Cancer. 2013;49:3049–54.

    Article  PubMed  CAS  Google Scholar 

  11. Hol L, van Leerdam ME, van Ballegooijen M, van Vuuren AJ, van Dekken H, Reijerink JCIY, et al. Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut. 2010;59:62–8.

    Article  PubMed  CAS  Google Scholar 

  12. Duffy MJ, van Rossum LGM, van Turenhout ST, Malminiemi O, Sturgeon C, Lamerz R, et al. Use of faecal markers in screening for colorectal neoplasia: a European group on tumor markers position paper. Int J Cancer. 2011;128:3–11.

    Article  PubMed  CAS  Google Scholar 

  13. Quintero E, Castells A, Bujanda L, Cubiella J, Salas D, Lanas Á, et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med. 2012;366:697–706.

    Article  PubMed  CAS  Google Scholar 

  14. Gatto NM, Frucht H, Sundararajan V, Jacobson JS, Grann VR, Neugut AI. Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst. 2003;95:230–6.

    Article  PubMed  Google Scholar 

  15. Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130–60.

    Article  PubMed  Google Scholar 

  16. Segnan N, Armaroli P, Bonelli L, Risio M, Sciallero S, Zappa M, et al. Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian Randomized Controlled Trial–SCORE. J Natl Cancer Inst. 2011;103:1310–22.

    Article  PubMed  Google Scholar 

  17. Knudsen AB, Lansdorp-Vogelaar I, Rutter CM, Savarino JE, van Ballegooijen M, Kuntz KM, et al. Cost-effectiveness of computed tomographic colonography screening for colorectal cancer in the medicare population. J Natl Cancer Inst. 2010;102:1238–52.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Minamimoto R, Senda M, Jinnouchi S, Terauchi T, Yoshida T, Inoue T. Detection of colorectal cancer and adenomas by FDG-PET cancer screening program: results based on a nationwide Japanese survey. Ann Nucl Med. 2014;28:212–9.

    Article  PubMed  Google Scholar 

  19. Negreanu L, Babiuc R, Bengus A, Sadagurschi R. PillCam Colon 2 capsule in patients unable or unwilling to undergo colonoscopy. World J Gastrointest Endosc. 2013;5:559–67.

    PubMed  PubMed Central  Google Scholar 

  20. Church TR, Wandell M, Lofton-Day C, Mongin SJ, Burger M, Payne SR, et al. Prospective evaluation of methylated SEPT9 in plasma for detection of asymptomatic colorectal cancer. Gut. 2014;63:317–25.

    PubMed  CAS  PubMed Central  Google Scholar 

  21. Tóth K, Sipos F, Kalmár A, Patai A V, Wichmann B, Stoehr R, et al. Detection of methylated SEPT9 in plasma is a reliable screening method for both left- and right-sided colon cancers. PLoS ONE. 2012;7:e46000.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pox CP, Schmiegel W. [German S3-guideline colorectal carcinoma]. Dtsch Med Wochenschr. 2013;138:2545.

    Article  PubMed  CAS  Google Scholar 

  23. Lansdorp-Vogelaar I, Knudsen AB, Brenner H. Cost-effectiveness of colorectal cancer screening. Epidemiol Rev. 2011;33:88–100.

    Article  PubMed  PubMed Central  Google Scholar 

  24. O’Morain C, Trinity CD, Lambert R. EU Guidelines for quality assurance in CRC screening and diagnosis. (International A for R on C, Rey J-F Institut AT). European Comission; 2010.

  25. Cairns SR, Scholefield JH, Steele RJ, Dunlop MG, Thomas HJW, Evans GD, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010;59(5):666–89.

    Article  PubMed  Google Scholar 

  26. Burn J, Gerdes A-M, Macrae F, Mecklin J-P, Moeslein G, Olschwang S, et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial. Lancet. 2011;378:2081–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Chan AT, Arber N, Burn J, Chia WK, Elwood P, Hull MA, et al. Aspirin in the chemoprevention of colorectal neoplasia: an overview. Cancer Prev Res (Phila). 2012;5:164–78.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  28. Nan H, Morikawa T, Suuriniemi M, Imamura Y, Werner L, Kuchiba A, et al. Aspirin Use, 8q24 single nucleotide polymorphism rs6983267, and colorectal cancer according to CTNNB1 alterations. J Natl Cancer Inst. 2013;105:1852–61.

    Article  PubMed  CAS  Google Scholar 

  29. Burn J, Bishop DT, Chapman PD, Elliott F, Bertario L, Dunlop MG, et al. A randomized placebo-controlled prevention trial of aspirin and/or resistant starch in young people with familial adenomatous polyposis. Cancer Prev Res (Phila). 2011;4:655–65.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  30. Ishikawa H, Wakabayashi K, Suzuki S, Mutoh M, Hirata K, Nakamura T, et al. Preventive effects of low-dose aspirin on colorectal adenoma growth in patients with familial adenomatous polyposis: double-blind, randomized clinical trial. Cancer Med. 2013;2:50–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  31. Bardou M, Barkun A, Martel M. Effect of statin therapy on colorectal cancer. Gut. 2010;59:1572–85.

    Article  PubMed  CAS  Google Scholar 

  32. Lochhead P, Chan AT. Statins and colorectal cancer. Clin Gastroenterol Hepatol. 2013;11:109–18. (quiz e13–4).

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  33. Tseng C-H. Diabetes, metformin use, and colon cancer: a population-based cohort study in Taiwan. Eur J Endocrinol. 2012;167:409–16.

    Article  PubMed  CAS  Google Scholar 

  34. Thosani N, Thosani SN, Kumar S, Nugent Z, Jimenez C, Singh H, et al. Reduced risk of colorectal cancer with use of oral bisphosphonates: a systematic review and meta-analysis. J Clin Oncol. 2013;31:623–30.

    Article  PubMed  CAS  Google Scholar 

  35. Higurashi T, Takahashi H, Endo H, Hosono K, Yamada E, Ohkubo H, et al. Metformin efficacy and safety for colorectal polyps: a double-blind randomized controlled trial. BMC Cancer. 2012;12:118.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

Download references

Take-home message

In Western countries colorectal cancer (CRC) accounts for almost about 10 % of all cancer deaths. CRC screening strongly reduces CRC morbidity and mortality, even after 20–30 years. Life style modifications as primary and secondary prevention are a warranted intervention for further decreasing CRC mortality and achieving a longer and healthier life.

Conflict of interest

Both authors declare that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Medicine and Cardiology, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria

    Paul Bergmeister MD & Alois Hermann Lang MD

  2. Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria

    Paul Bergmeister MD & Alois Hermann Lang MD

  3. Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein

    Paul Bergmeister MD

Authors
  1. Paul Bergmeister MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alois Hermann Lang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Bergmeister MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bergmeister, P., Lang, A. Colorectal cancer: screening and some notes on the prevention. memo 7, 187–191 (2014). https://doi.org/10.1007/s12254-014-0154-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12254-014-0154-8

Keywords

Search

Navigation