Over 48,000 new diagnoses in 2022: 90% could be prevented with the Sof screening test (offered every two years to 50-69 year olds), but only 45% of citizens in the North accept the invitation from the ASL, 31% in the Center and 10% in the South
That of the colon one of the types of cancer most widespread all over the world and also one of the deadliest, although there is an effective way to diagnose it early and save your life. Not only that: cases are on the rise, also in Italy and, unfortunately, also among young people (even before the age of 40). In 2022 they were estimated 48,100 new diagnoses of colorectal cancer
, while in 2020 there were just over 43,700. And it gets worse: if this neoplasm, in the pre-Covid era, had been the example of the effectiveness of prevention programs with screening for which both cases and mortality had decreased, due to the pandemic and the accumulated delays during the health emergency we took a step backwards. Seven out of ten citizens do not take the occult blood test, which the health system offers free of charge every two years to all 50-69 year olds – he underlines Saverio Cinieri, president of the Italian Association of Medical Oncology (Aiom) —. For this Aiom has promoted a major awareness project to improve test adherence. Commercials, brochures, a strong social campaign will be created and the active involvement of pharmacies is expected.
Nine out of ten cases could be avoided
The objective, in essence, is twofold: to ensure that the Italians who receive the letter of invitation to be screened with the test for the search for occult blood in the faeces do not throw it away and to sensitize everyone, young and old, to do not ignore possible alarm bells. On both fronts, time is a precious ally against cancer. The sooner a neoplasm is discovered, the greater the chances of a definitive cure and to do so with less invasive therapies. The very important fact that nine out of ten cases could be avoided if everyone did the checks, but half of Italians do not take the opportunity – he clarifies Sara Longardi, Acting Director of Oncology 3 at the Veneto IRCCS Institute of Oncology in Padua —. There is an effective, free (in Italy) and completely painless method to eliminate pre-cancerous lesions before they turn into a real neoplasm: the fecal occult blood (FOB) test. Colorectal carcinomas develop from adenomas or polyps that take years, on average ten, to transform into malignant forms and in this time window that screening with the Sof allows you to do an early diagnosis ed eliminate intestinal polyps before they have acquired dangerous characteristics and evolve into a malignant tumor. If the Sof is positive, the patient is sent for one colonoscopy which allows you to highlight and remove any precancerous lesion or perform a biopsy.
Symptoms and who is most at risk
In the beginning, colon cancer does not show obvious signs. Signs of early disease are non-specific and include changes in bowel habits, abdominal discomfort, weight loss and persistent fatigue – continues Lonardi -. When the most advanced pathology can occur bleeding during bowel movements, abdominal pain, nausea or vomiting. 20% of cases, unfortunately, discovered late. A crucial role in prevention instead given by healthy and balanced nutrition: dietary factors such as the consumption of red meats and sausages, refined flours and sugars and the consumption of salted, preserved or smoked foods raise the danger of getting sick, such as excessive consumption of alcoholic beverages and the smoke. The odds also increase for who overweight, obese and does little physical activity. A protection, on the other hand, can be produced by the consumption of fruits and vegetables, unrefined carbohydrates, vitamin D and calcium. Colorectal cancer in Italy is the second most frequent after breast cancer – underlines Cinieri -: while trying to make up for the delays caused by Covid, it is essential that everyone does their best to prevent it. Territorial differences in screening with the Sof test must also be bridged, given that membership reaches 45% in the North, 31% in the Center and only 10% in the South. Furthermore, it is important that the test is also extended to the over 70s. This way we will be able to save more lives. Only five Regions exceed the target of 50% participation: Veneto is the most virtuous (almost 70%), followed by Trentino, Valle d’Aosta, Emilia-Romagna and Friuli Venezia Giulia.
20% of cases discovered in the metastatic stage
In Italy, 65% of patients live five years after diagnosis and there are more and more patients who, even if they cannot recover, they manage to live with the neoplasm for several years and have a good quality of life. So much so that around 513,000 compatriots today live after receiving the news of colorectal cancer. Unfortunately, 20% of cases are still discovered late today, when metastases have already developed, but the prognosis of these patients has improved markedly in recent years. The steps forward are linked on the one hand to new biological knowledge, on the other toidentification of particular molecular targets which constitute the target of innovative therapies says Lonardi. That is, knowing the DNA mutations present in a patient’s neoplasm, the molecular characteristics of the individual tumour, today essential for guiding therapeutic choices: in fact there are genetic alterations which, if present, can provide the clinician with very important information on the biological aggressiveness of the tumor and on the possibility of responding or not to therapies. In this way, we can identify the best strategy for the individual patient, with savings for the health system as well, recalls Cinieri.
Genetic mutations: why the test is needed
Colorectal cancer is an extremely heterogeneous neoplasm from a genetic-molecular point of view — he clarifies Philip Pietrantonio of Gastroenterological Medical Oncology at the IRCCS Foundation Istituto Nazionale Tumori di Milano —. Most patients with metastatic colorectal cancer are ineligible for potentially curative surgery. At the time of starting the treatment, the evaluation of the mutational status of the genes indicated with the acronym RAS (KRAS and NRAS), of BRAF and of those involved in the DNA repair functions “mismatch repair” and of the “high microsatellite instability”. These genes (which are an indicator of a defective DNA repair system) function as “switches” that activate the growth and replication mechanisms of cancer cells and they can be in the normal or mutated state: today we know that this malfunction is a predictive factor for the response to certain drugs. About 5% of patients show metastatic high instability of microsatellitesfrom which a high number of mutations derives: a characteristic that seemed to reduce the probability of benefiting from traditional chemotherapy, but now turns into a sort of advantage, because it allows to select a subgroup of patients highly responsive to immunotherapy. The normal status of KRAS and NRAS, which represents about 40-45% of the total cases of metastatic colorectal cancer, indicates that the patient is more likely to respond to anti-EGFR monoclonal antibody therapy – concludes Pietrantonio , who is a member of the Aiom national executive -. BRAF mutation detected in about 10% of cases and associated with a worse prognosis, because the tumor is more aggressive and for greater resistance to therapies. The V600E mutation is the most frequent among those of BRAF and the risk of mortality in these patients is more than doubled compared to those “non-mutated”. In these cases, however, the availability of a targeted therapy allows improvements in survival.
March 21, 2023 (change March 21, 2023 | 09:32)
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