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Is increased colorectal screening effective in preventing distant disease?
Gaius Julian Augustus1,2, Denise J Roe2, Elizabeth T Jacobs2
1Cancer Biology Graduate Interdisciplinary Program, Tucson, AZ.
Plos One
|July 13, 2018
Summary
Colorectal cancer (CRC) screening shows slower reductions in distant disease incidence than expected. This suggests CRC screening may not effectively prevent advanced cancers, possibly due to rapidly advancing subtypes.
Area of Science:
- Oncology
- Public Health
- Cancer Epidemiology
Background:
- Colorectal cancer (CRC) screening is expected to reduce incidence across all disease stages.
- Widespread colonoscopy use since 2000 has decreased overall CRC incidence by 29%.
Purpose of the Study:
- To investigate if incidence rate reductions for colorectal cancer (CRC) differ by disease stage.
- To assess the effectiveness of screening in preventing distant (metastatic) CRCs.
Main Methods:
- Analysis of Surveillance, Epidemiology, and End Results (SEER) program data from 2000-2014.
- Evaluation of incidence trends for localized, regional, and distant colorectal cancer (CRC).
- Stratification of data by race, age, tumor location, and sex to identify subgroup trends.
Main Results:
- Incidence of distant colorectal cancer (CRC) decreased slower than localized and regional disease from 2000-2014.
- This trend persisted across all demographic and tumor characteristic subgroups.
- Distant CRCs constituted an increasing proportion (21% in 2014) of all CRC cases.
Conclusions:
- The slower reduction in distant colorectal cancer (CRC) incidence challenges the effectiveness of current screening protocols for preventing advanced disease.
- Inadequate screening does not fully explain the observed trends.
- A rapidly advancing, potentially undetected subtype of colorectal cancer (CRC), possibly microsatellite stable, is hypothesized to exist.
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