21 Countries, 16 Years: Massive Study Shows Impact of Colorectal Cancer Screening

David J. Kerr, CBE, MD, DSc


October 07, 2021

This transcript has been edited for clarity.

I'm David Kerr, professor of cancer medicine from University of Oxford in England. I have had a lifelong professional interest in the biology and treatment of colorectal cancer. A nice paper popped up recently in The Lancet Oncology, looking at the impact of colorectal cancer screening.

I've said this many times before, but as I've become older, more mature (one might argue), and wiser (possibly), I've become interested more in the concept of prevention rather than cure, given the relatively sparse armamentarium of drugs that we have to manage colorectal cancer. This excellent paper reports an outstanding European-wide study of 21 countries over 16 years, from 2000 until 2016. Investigators used data that were gathered from national cancer registries, as far as possible, to examine the incidence, mortality, and stage of presentation of colorectal cancer in these countries. And they conducted various computations for each of these.

It was a huge study of 3.1 million patients, so, fantastically powerful. Weaknesses, admitted by the authors themselves, include the different times screening programs were implemented — some were ad hoc, some were nationally driven; different methodologies, in terms of screening interventions, which changed over time as new technology became available; and different means of registration.

Nevertheless, it's a powerful study that showed that, by and large, those countries that implemented a national screening program that was well followed with good uptake showed improvements in reducing the incidence of disease and the burden of colorectal cancer, with associated improvements of mortality and stage migration — we're seeing more stage I and stage II patients. That's the good news.

This is in contrast to those countries that didn't implement national colorectal cancer screening programs, such as Bulgaria, Estonia, Norway, and Ukraine, where we actually saw gradual increases in the incidence of colorectal cancer. So this is a story of divergent trends giving us some idea of the impact that colorectal cancer screening has had across this broad European population.

We know that other advances have been made during this period of time, including surgical-site specialization and multidisciplinary teamwork. But colorectal cancer screening has been impactful. Perhaps a message to those countries that don't have screening programs is that they might want to get their acts together and consider how they might implement national colorectal cancer screening programs. That's a message that could perhaps echo around other well-resourced countries; there is no doubt that colorectal cancer screening saves lives.

Thanks for listening. Have a look at the paper. It is well done, given the sort of limitations I mentioned. Huge database, excellent group, interesting reading. Thanks for listening, as always. I'm very interested in any comments that you may care to make. For the time being, Medscapers, over and out.

David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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