March is the month of the national screening for colorectal cancer, a campaign that speaks to all people between 50 and 74 years. Why? What are the issues? How not to confuse detection and prevention, screening and diagnosis of cancer?
Information on colon cancer screening
Screening is to detect cancer at its earliest possible stage. In the case of colorectal cancer, it is also the detection of pre-cancerous tumor that represents a colon polyp in the process of malignant transformation. Benign polyps (adenomas) colon cancer but not in cancerous potential in 60-85% of cases. It is therefore preferred to withdraw whenever it finds.
Implemented since 2009 throughout the country, screening for colorectal cancer is open to all men and women aged 50 to 74, every two years. It is widespread and systematic, as opposed to individual screening practiced by physicians in their patient base. Nearly 17 million people are involved in this program under the responsibility of the Ministry of Health and managed by the Directorate General of Health (DGS).
It is a measure of the Cancer Plan 14 government (2009-2013), all the more crucial that the turnout is low spontaneously: the cancer is far! Better not think about it ... Only 5 million people (about 17 million invitations) did the test in 2009-2010, 34%. Or desirable to reduce significantly (15-20%) deaths rate is higher than 50%. Ideally, it should reach 65% of 50-74 years.
Risks and consequences of colon cancer
Colorectal cancer is the third most common cancer with 40,000 new cases estimated in 2010 after breast cancer (71,500 new cases) and prostate cancer (52,500 cases). It causes 17,400 deaths annually (estimated number in 2010), is the second leading cause of cancer death, after lung cancer.
His prognosis is good, however when taken in time; "cure" is the rule in the majority of cases (90% of patients alive at 5 years). A fortiori if one removes a polyp or a pre-cancerous stage; recovery is 100% true then.
However, taken at a late stage of invasion of viscera (liver damage and pancreas) and / or distant metastases, it is difficult to control and requires mutilating surgical cuts. This may result in a definitive stoma.
Through screening undertaken since 2003, more than 13,500 cancers were detected, and more than 54,000 adenomas (polyps) in which 31,000 degeneration.
People affected by colorectal cancer screening
The screening is for people 50 to 74 years of both sexes, provided they have no specific risk factors to cancer. That is to say they have no evidence suggestive and do not have a history. They are called medium risk as the only factor used is age: the cancer is (essentially) a disease of aging cells.
If they are part of a family colonic polyps and / or colorectal cancer frequent if they have already had one or more polyps or colon cancer, so they follow a monitoring program apart. As well as people with diseases that may irritate (inflammation) lasting the gut, thus promoting cell carcinogenesis.
Screening for colorectal cancer: what are the principles?
Colonic cancers bleed, but often capriciously. Thus research of blood in the stool, knowing that many other causes can bleed the digestive tract. But we will move to a different diagnosis after checking that there is no colo - rectal cancer.
Having visible blood in the stool should lead quickly to the consultation of the attending physician, who will decide on the way forward. This is not the most common and generally corresponds with advanced cancers. Most often the bleeding is occult in early cancer development.
The test used by the health management is the Hemoccult II®, said "guaiac test", it detects the presence of blood invisible to the naked eye in the stool. It is currently under discussion because of the analytical techniques progress. However, no change is likely before two or three years because of administrative procedures, in particular the assessment of the cost of a more expensive immunological procedure.
How are screened?
Every two years, the county association in charge of screening for people involved an invitation to remove the test from their physician.
The next step is to make yourself at home spreading a little stool on a stamp pad with three stools away. Then everything is mailed to the processing laboratory. In case of constipation, performing the test is longer because the seats are spaced. In case of diarrhea, it is the opposite. As you need your test handy during this time, it is advisable to do so for a holiday.
The test is free but not consulting the doctor. The mailing is free. His analysis is free.
If the test is negative (97% of cases), the person will be requested again two years later.
In case of a positive test, the person is invited to consult your doctor to prescribe that a screening colonoscopy (gold standard), also free.
While colonoscopy is positive (presence of polyps and / or cancer), the patient enters a custom protocol followed.
If colonoscopy is negative, the test is no longer required before five years (mean time to development of polyps) provided that doctors (and treating gastroenterologist) agree.
Taken together, these measures represent a total cost of 70 million euros in 2010 supported 100% by the Ministry of Health and health insurance.
What are the differences between screening, diagnosis and prevention?
Screening research disease or pre-disease. It identifies presence or suspects sign, but he did not assert. It can be individual case by case, to be organized systematically in the whole population so widespread.
The diagnosis is the certainty of a perfectly identified disease. It is rare that a screening procedure also gives the definite diagnosis. But it is the case during a colonoscopy because the doctor can see the tumor and formally recognized. In the wake of it the fee in whole or in part when it is too big (biopsy). The sample is then examined by a histologist (or pathologist) confirms the visual diagnosis and gives a name to the tumor. Sometimes it is necessary to make additional laboratory tests on the tumor to refine its identity, and thus prognosis. For the development and severity of cancers depend on their cellular nature.
Prevention involves behaviors that limit cancer cell transformation. For example, do not smoke and do not live in a free environment is the best way to reduce the risk of lung cancer. However, few cancers caused by a single factor heavily. Most often it is a combination of small factors that accelerates carcinogenesis, as in rectal cancer co-lo is known that residues of the digestion of meat, especially overcooked or charred (BBQ) increase the risk.; it is also the case with chronic bowel disease by persistent inflammation they cause.
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