For whom colorectal cancer screening is useful?

In many countries, Doctors recommend that all people aged 50 years and above, to on colon cancer testing. The goal: to detect tumors early and to treat, as long as the disease is still curable. This also applies to Germany. Now an international panel of experts, calls into question these recommendations.

Routine testing should not be all people between the ages of 50 and 79 years, equally offered, call the 21 experts in the “British Medical Journal”. The reason is that There is this group of people with such a low colorectal cancer risk, the burdens and risks might fall through the Tests in more weight – for example, through fear, or the risk of complications during colonoscopy.

The experts Lise Helsingen of the University of Oslo, argue for a different approach: in your opinion, should develop the disease in the age group of those people to the Screening, which carry a risk of three percent in the next 15 years to colon cancer. The decision for or against the investigation should not, however, without medical advice, as the experts.

In addition, this recommendation applies only to people who are symptom-free – so not, for example inexplicable weight have lost and the disease have no symptoms such as chronic inflammatory bowel disease that increase the risk of colon cancer.

Two possibilities: Tests for blood in the stool or colonoscopy

Colorectal cancer in Germany after breast cancer is the second most common cancer. Per year, nationwide, more than 60,000 cases are diagnosed new. Risk factors include poor diet, lack of exercise, alcohol and tobacco apply in addition to hereditary factors.

In the case of preventive examinations, including Tests for blood in the stool is used. In addition, people in Germany can perform at the cost of the health insurance companies colonoscopies (colonoscopies), with the tumors and their precursors can be detected early. The precursors can be removed in the Mirroring, in addition, as a precautionary measure.

For its new recommendations, the group of experts found that individual risk of a Person to develop in the next 15 years for colorectal cancer, the risks as well as the mental stress due to the examinations. Accordingly, the Benefit of the investigation outweighs only from a colorectal cancer risk by three percent.

In order to calculate the risk, the experts suggested an Internet-computer – the “Q Cancer Calculator”. This determines the individual risk including age, gender, height, weight, tobacco and alcohol use, or a familial risk of cancer.

German experts: risk to overlook tragic diseases

Hermann Brenner from the German cancer research center (DKFZ) in Heidelberg provides both the Online Instrument, as well as the recommendations of the authors critically: “The calculator does not ask for the risk factors, only very roughly, so that the result is reliable.”

Overall, he felt great skepticism about the new recommendations, says the epidemiologist, is the head at the DKFZ, among other things, the Department of Preventive Oncology. “The recommendation considers the question of whether screening is useful, completely from the personal perspective of the participants. For the risk assessment, however, is much too coarse.”

The recommendations would lead to the majority of women and men only after the age of 60. Age would start with the bowel cancer screening. Just about the most particularly tragic illnesses and deaths in younger years of life could no longer be avoided.

The possibilities of Screening are enormous: “If the vast majority of people would go in the appropriate age levels only once for the preventive colonoscopy, then you could avoid more than half of the deaths from colorectal cancer”, emphasizes the burner.

Stool test: an Alternative for the treatment of anxiety in front of the Mirror

The argument that Fears and unpleasant sensations can be connected with the investigations, counters burner with regard to the less onerous stool test: “Who would not want to opt for the colonoscopy, you can regularly have a chair test. Even so, the majority of still every year, more than 25,000 deaths from colorectal could be cancer in Germany.”

In Germany, men can choose for a few months starting at the age of 50 years, between one annual stool blood test and colonoscopy every ten years. Women have until the age of 55 years are entitled to a colonoscopy.

“In Germany, only five to six percent of the persons Entitled to Screening every year,” says Thomas Seufferlein, Medical Director of the clinic for Internal medicine at the University hospital Ulm. “This is not to say that the Problem of over-diagnosis, the the new recommendation, and to confront, Germany is like other countries where many more people participate in colorectal cancer screening.”

In Germany, it was rather important, “the fact that we motivate for the Screening”, says the expert of the German society for gastroenterology, digestive and metabolic diseases (DGVS).

It is crucial to make clear that colorectal cancer is not a disease, you recognize only early, but when you even could provisions. “If it is removed early precursors, this saves the patient a lot of stress: the psychological shock of the cancer diagnosis, the surgery and the aftercare,” stresses Seufferlein.