With almost 44 thousand new cases registered in 2020, colorectal cancer is the second most frequent type of cancer in our country and also the second in the unlikely ranking of the deadliest, yet nine out of ten cases could be avoided because there is an effective method , free (in Italy) and completely painless to eliminate pre-cancerous lesions before they turn into a real neoplasm: the test for the search for occult blood in the faeces (Sof). The numbers show how useful it is to participate in screening: not only is the number of patients who survive long after the tumor is discovered (thanks also to the new therapies available), but also the number of cases of cancer diagnosed because they are identified and removed polyps and adenomas when they have not yet evolved into carcinoma. Important results, obtained thanks to increasingly effective treatments and prevention campaigns, which risk being compromised by the pandemic that stopped screening for months, with skipped examinations and long accumulated delays.
A million skipped exams
Sof test, mammography, Pap test or Hpv-Dna test save thousands of lives every year, allowing you to discover the presence of a tumor in the early stages, when it is easier to treat and the chances of healing are greater – underlines Giordano Beretta, national president of the Italian Association of Medical Oncology (Aiom) which launches an appeal for screening programs to be relaunched and also expanded – Due to Covid-19, screening programs in 2020 had a sharp setback: compared to the year previous, more than 1 million and 110 thousand examinations for colorectal cancer have been missed. In total, 1,300 fewer cases of cancer and 7,400 fewer advanced adenomas were identified.The Sof test is offered by the National Health Service to all citizens between 50 and 70 who receive, every two years, a letter from their own Asl with the invitation to go to the nearest pharmacy to collect a small container in which to collect a stool sample, to then return it and receive the letter with the report at home within a couple of weeks. From 2013 to date, the incidence of colorectal cancer dropped by 20% and in 2020 over 43,700 new cases were identified. Decisive, in order to be more likely to heal, also do not neglect the main alarm bells that must be reported to the doctor, especially after the age of 50: presence of bright red blood, sometimes mixed with mucus, in the stool, sense of incomplete evacuation, weight loss with no obvious cause.
65% of patients live five years after diagnosis
The advantages of the examination are also evident in the improvement in survival at 5 years, which has increased from 52% in the 1990s to 65% today, also due to the effectiveness of therapies in the most advanced stages. Covid-19 may have compromised this good result and therefore we reiterate, once again, the need to relaunch secondary cancer prevention campaigns – says Beretta -. And also to extend it up to 74 years, since this neoplasm affects mainly from 65 years onwards. Furthermore, from a survey conducted among Italian oncologists, conducted as part of the Diagnostic Tests in Colorectal Cancer project (carried out thanks to the unconditional support of Pierre Fabre) dedicated to patients and caregivers and doctors, the importance of always perform the molecular test in patients that is used to select the therapy for those with an advanced disease. Of the new cases identified every year in Italy, about 10 thousand present metastases already from diagnosis. Colorectal cancer is an extremely heterogeneous neoplasm from a genetic-molecular point of view and therefore to defeat it, it is necessary to define the characterization of the molecular biology of each individual case – clarifies Beretta -. Thus we can better define the therapeutic strategies, guarantee the best diagnosis to the patient and above all administer drugs only when they are necessary and useful. All this allows us important savings for the national health system as well.
Molecular test for the right drug
The use of a scalpel is usually the first step in the fight against cancer and consists in the removal of the intestinal tract affected by the tumor. Chemotherapy, radiotherapy are also used and several new drugs are available: depending on the case, they can be prescribed before or after surgery, to reduce the volume of the mass to be removed and proceed with a less invasive operation, or to limit the risk of relapse or metastasis. When metastatic disease, chemotherapy and other medicines are useful in prolonging survival, counteracting the symptoms of the disease and improving the quality of life of patients, the Aiom survey shows that nine out of ten oncologists carry out the assessment of the mutational status of BRAF V600 before undertake first-line treatment for metastatic colorectal cancer. This mutation is present in 10% of patients – explains Saverio Cinieri, Aiom president-elect -. It can provide valuable prognostic information and give us insights into the evolution of the disease. It is associated with a worse prognosis as the tumor is more aggressive and more resistant to the main treatments. Some recent scientific studies have highlighted the high activity of a combination including Cetuximab and Encorafenib in patients with progressive B-RAF mutation after a first line of treatment. The BRAF analysis should therefore always be performed in clinical practice, as fortunately our survey highlights. In fact, only 6% of the interviewees said they did not take the test mainly due to logistical, organizational or administrative problems. Molecular tests must always be guaranteed for all patients and on the entire national territory also by exploiting, where they are available, the paths of the Regional Oncological Networks.