Colorectal Cancer Screening and Surveillance for Non-Hereditary High-Risk Groups—Is It Time for a Re-Think?

Abstract

Purpose of review Colorectal cancer (CRC) is the second most common cause of cancer death worldwide, killing approximately 900,000 people each year. An individual’s risk of developing CRC is multi-factorial with known risk factors including increasing age, male sex, family history of CRC and raised body mass index. Population-based screening programmes for CRC exist in many countries, and in the United Kingdom (UK), screening is performed through the NHS Bowel Cancer Screening Programme (BCSP). Screening programmes offer a population-based approach for those at “average risk”, and do not typically offer enhanced screening for groups at increased risk. In the UK, such patients are managed via non-screening symptomatic services but in a non-systematic way. Recent findings There is growing evidence that conditions such as cystic fibrosis and a history of childhood cancer are associated with higher risk of CRC, and surveillance of these groups is advocated by some organizations; however, national recommendations do not exist in most countries. Summary We review the evidence for screening “high risk” groups not covered within most guidelines and discuss health economic issues requiring consideration acknowledging that the demand on colonoscopy services is already overwhelming.

Esophageal squamous cell carcinoma at the site of tracheo-esophageal fistula repair in a patient with cystic fibrosis

“…The majority of malignancies seen in patients with CF are in the GI tract including bowel, colon, pancreas and biliary tract, especially in the lung transplant patients whose risk for colon cancer is reported to be much higher (Standardized incidence ratio [SIR] 30.1, 95% CI 4.2 to 9.0) than Lynch syndrome (SIR 6.04, 95% CI 3.58 to 9.54) 1 15. Esophageal cancers are extremely rare.…”

Evaluating the Effectiveness of a Modified Colorectal Cancer Screening Program in Almaty, Kazakhstan

“…These issues contribute to the substantial frequency of late-stage cancer detection or delayed discovery of precancerous colorectal conditions. One primary challenge is the insufficient response rate from the target screening population (Hampton et al, 2021). This issue is especially prevalent in healthcare systems that lack experience and sufficient organizational capabilities (Goyal et al, 2020;Podda et al, 2021).…”

Results of Colorectal Cancer Screening in the Almaty Region of Kazakhstan Using a Modified Organizational Program

“…Несмотря на большую степень разработанности и длительную практику в плане его осуществления, до настоящего времени сохраняется ряд проблем, снижающих эффективность и определяющих значительную частоту запоздалого выявления рака и/или предраковых заболеваний колоректальной области. Ведущей из них служит недостаточный отклик лиц, подлежащих скринингу [11]. В наибольшей степени эта проблема характерна для систем здравоохранения, имеющих относительно малый опыт и организационные возможности [12,13].…”