cThe increase continues, which in some countries began a few years ago, of colorectal cancer incidence in the under 50s. This time the data is from by the American Cancer Society and indicate that in the United States the percentage of colorectal cancer diagnoses among people under the age of 55, it has almost doubled over the past three decades. In 2019, around 20% of new colorectal cancer diagnoses, i.e. one in five cases, involved people under 55, compared to 1995 when it was one in ten cases (11%).
Colorectal cancer: looking for the causes
The incidence and mortality from this tumor, therefore, decreasing also thanks to screening, are once again a cause for concern. The causes of the increase among young people are not yet clear: according to the researchers, a change in known risk factors for this cancer, including unhealthy diets, alcohol consumption and physical inactivity, could contribute, but not fully explain the trend.
Thus, some disease risk factors may still be identified, such as the reason for the increase in left-sided versus right-sided cancers, despite the increased effectiveness of screening in detecting lesions and thus preventing them. . Furthermore, the American Cancer Society points out, the advanced stages of diagnosis increase.
The first guidelines for the under 50s
In anticipation ofincrease in juvenile caseshave been published first international guidelines for the treatment of juvenile colorectal cancer, taking into account the scientific evidence for this age group. The document, just published in the magazine Clinical Gastroenterology and Hepatologyis the result of the work of an international group led by Giulia Martina Cavestro, head ofFunctional Unit GASTRO FOR ME (GASTROenterological PERsonalized MEDicine) of the Gastroenterology and Digestive Endoscopy Unit at the IRCCS San Raffaele Hospital.
Colorectal cancer also affects women
In Italy, colorectal cancer is the second most common cancer in women and the third in men. They occur across the sexes: according to the Aiom Report “The numbers of cancer in Italy” in 2022 there were 48,100 new cases, of which 26,000 in men and 22,100 in women, up compared to 2020 respectively by +1.5 % and +1.6%.
The lower effectiveness of screening in women
The Istituto Superiore di Sanità, in two recent documents, the Methodological Manual for the production of the ISS guidelines and the Operational Manual for the procedures for sending and evaluating Guidelines for publication in the SNLG, has requested that gender differences are included in the criteria for developing and updating guidelines so that specific sex and gender recommendations are produced based on evidence from the scientific literature.
In particular, in colorectal cancer, the gender approach leads to the following conclusions in terms of prevention: estrogen therapy may have a protective role in tumor development in familiar postmenopausal women; there need to extend the age screening in women, given the onset of cancer at an older age in women; the lower efficacy of the fecal occult blood test as a screening tool in women, with a higher probability of false negatives than observed in men, due to the more frequent localization of the tumor in the right ascending colon; the need to use medical devices appropriate to the female anatomy, due to the greater length and smaller diameter of the female transverse colon.
Fecal occult blood test
The screening test used in almost all screening programs is the fecal occult blood testexecuted every 2 years in people between 50 and 69 years old. Traces of blood are an indication of the possible presence of malignant lesions of the mucosa and adenomatous polyps, lesions which may eventually evolve into cancer, which in 80% of cases take from 7 to 15 years to transform into malignant forms and which can be removed endoscopically.
A gap between areas of the country
On the occasion of World Cancer Day, al AIOM congressPaola Mantellini, head of the National Screening Observatory, showed the national data: although participation in screenings in 2021 returned overall to the pre-pandemic period, regional differences have not been annihilated.
The north-south gradient is present in the coverage indicator of each screening programme, a value which takes into account two elements: the ability to provide a service (screening) and the propensity of the population to adhere to the invitation. In the case of colorectal cancer, five regions are under 50% and none of the South.
According to the data Steps, the overall coverage for early diagnosis reaches higher values in the North (65%) and in the Center (60%), while it is lower in the South (24%). At the level of the individual regions, looking at the execution of control tests within and outside the screening programmes, it ranges from values such as 75% in Tuscany, 73% in Friuli Venezia Giulia and 71% in Veneto, to 7 % of Calabria, 10% of Puglia and 24% of Campania.
The Umberto Veronesi Foundation
There Umberto Veronesi Foundation was born in 2003 on the initiative of Umberto Veronesi and many other internationally renowned scientists and intellectuals, including 11 Nobel Prize winners, with the aim of promoting scientific research of excellence and prevention, health education and science dissemination projects. The Foundation’s activities renew every day the vision of its founder Umberto Veronesi, a doctor who has dedicated his life to developing innovative scientific knowledge to put it at the service of the well-being of his patients.
The foundation:
- supports the scientific research through the delivery of research grants for doctors and researchers and finances projects very high profile that can develop new knowledge and new treatments for oncological diseases
- accomplish prevention campaigns and education that promote the adoption of healthy and mindful lifestylesin synergy with schools and with public and private realities in the world of research, information and publishing
- organize international conferences that tell the future of science and the role it can play in promoting peace and the well-being of peoples.
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