Opinion: Colorectal cancer: the ball of the day

For several years, the international medical community has been issuing warnings to the population on how to prevent or make an early diagnosis of the most frequent tumors. This is justified because its reflection is a number of cases below the statistically expected, a greater number of cases diagnosed early and, therefore, with a much greater probability of cure, less individual and family suffering and, also importantly, with less costs for the patients. health systems.

In March, the tumor fought against is colorectal cancer, whose incidence continues to grow worldwide, with around 2 million new cases being diagnosed annually. Unfortunately, when the diagnosis is made based on clinical symptoms, more than 30% of patients already have disseminated disease, which significantly reduces the chance of cure, something that contrasts with cure rates of 90% for cases diagnosed early.

Over the last three decades, several medical societies have been concerned with proposing programs for the prevention and early diagnosis of colorectal cancer, and several studies have already shown a decrease in the number of cases in the populations that participate in these programs. These are designed according to the individual risk of developing colorectal cancer throughout life, defining three distinct risk groups: low, medium and high.

In the low-risk group are people under 45 years of age who do not have predisposing factors, such as genetic mutations transmissible from parents to children or inflammatory bowel diseases. The average risk group includes those over 45 years of age, which is the age at which the vast majority of colorectal tumors appear.

The high-risk group, on the other hand, includes people with certain genetic mutations, especially members of families with two hereditary diseases, which fortunately correspond to about 5% of all cases of colorectal cancer, which are Lynch syndrome and polyposis. familial adenomatous. This group includes, at a lower risk than these syndromes, first-degree relatives of patients with colorectal cancer and patients with specific diseases (such as inflammatory bowel disease).

It is according to the risk that prevention and early diagnosis programs are structured. Thus, the low-risk group does not need examinations or evaluations. For the average risk group, colonoscopy is recommended every 5 to 10 years, probably until age 80. If adenomatous polyps are found, the intervals between colonoscopies tend to decrease. Some programs suggest periodic testing for fecal occult blood between colonoscopies.

For high-risk populations, prevention and early diagnosis programs vary according to the underlying problem, and it is not appropriate to explain them in this limited space.

It must be clear that any cancer prevention and early diagnosis program depends on knowledge of the risks and individual motivation to minimize them. On the other hand, it is a fact that our public system is not able to afford the tens of millions of colonoscopies required for a comprehensive program. As a reflection, it is worth mentioning that, in the current phase, high-risk populations should be prioritized, as well as medium-risk populations from geographic regions with higher incidences of colorectal cancer, which in Brazil are the Southeast and South regions.

A comment: everything that has been said above concerns the so-called secondary prevention, but there are attitudes related to primary prevention that can reduce individual risks for developing colorectal cancer in adult life and that should start to be valued from childhood, especially those related to the diet, which should be rich in plant fibers and restricted in the intake of animal fats, in the practice of aerobic exercises and, also in a relevant way, avoiding obesity.

In conclusion: like yourself and be sure to take the measures that can help you not to develop this tumor. Life thanks you!