Colorectal cancer: early detection from the age of 30?

Risk is often inherited

Most of the 10 percent of early patients have one thing in common: They have a family-related increased risk of colon cancer. Because the probability of becoming ill not only increases with age, it is also significantly increased by various genetic variants.

The idea of ​​offering this group preventive medical check-ups much earlier makes sense. The Bavaria-wide model project FARKOR has now examined whether this is really worthwhile. FARKOR stands for “Precaution in the event of a family risk of colorectal carcinoma” and was launched by the Felix Burda Foundation.

“The aim of the project is to offer people with a family history risk-adjusted colon cancer screening,” write the initiators. The aim is to reduce the mortality rate from colon cancer in those under 50 years of age. Because while this has fallen significantly among older people thanks to screening from the age of 50, it is continuously increasing in younger age groups.

The results of the study were presented at a press conference:

Since 2017, more than 25,000 people between the ages of 20 and 50 have been asked by their general practitioners about the possibility of having their personal colon cancer risk clarified for the study. In the first step, four simple questions are sufficient:

Is in your family…

• … a close relative (parents, siblings or children) has colon cancer?
• … a person under the age of 60 develops colon cancer?
• … two people developed colon cancer?
• … a person suffers from another form of cancer in addition to colorectal cancer?

If you answer “yes” to even one of these questions, you should have yourself examined regularly.

One in five has a family history

On this basis, the doctors classified 5769 of the participants as having a family history – i.e. around one in five. The doctors develop a more in-depth risk profile for them. 1188 of the participants then decided to have an immunological stool test, 1595 took advantage of a more complex but much more reliable colonoscopy.

Overall, early-stage adenomas were identified in 232 participants. These are intestinal polyps , from which colon cancer tumours often develop later. Advanced-stage adenomas were found in 60 participants, and colon cancer in four.

Hit rate corresponds to that of older people

The hit rate thus roughly corresponds to that achieved as part of general colorectal cancer screening from the age of 50.

And this despite the fact that the study has a large and annoying data gap. How it went on with those participants who opted for an immunological stool test instead of the colonoscopy was largely not documented by the participating doctors. Only 11 of them were recorded as having a colonoscopy after a positive test result.

Intestinal check from 30 is worthwhile for people with previous problems

Nevertheless, the initiators rate the study as a success. Even so, the data clearly show that it is worthwhile for those with a family history to have an intestinal check from the age of 30 and then regularly up to the age of 70.

This not only benefits those examined, who may be spared colorectal cancer through timely removal of the polyps, or whose tumours may be detected at an early stage.

The project also turned out to be a stroke of luck from a financial point of view: On the basis of this indication, around 3 to 4 percent of the population could be additionally examined. Significantly greater than these costs, however, would be the savings from therapies that have become unnecessary – the earlier a tumor is discovered, the less expensive it needs to be treated.

Nationwide from 2023?

The experts expect that the project can be rolled out nationwide as early as 2023. If you have a family background and want to be examined of your own accord, you don’t have to wait: on the doctor’s advice, the health insurance companies already cover the costs.

So demonstrating the effectiveness of earlier colorectal cancer screening in families with a family history seems to be setting things in motion. This is not something that can be taken for granted, particularly in pension projects.

On the one hand, it is an investment that will only pay off in the future. “Politics, however, are primarily focused on the present,” explains Prof. Gaby Sroczynski from the Private University for Health Sciences, Medical Informatics and Technology GmbH (UMIT) in Tyrol. And that’s where the strategy initially causes additional costs.

On the other hand, the main focus is on people who are already ill and who need urgent help. There are names of them, there are dates, there are medical histories. Those who do not become ill as a result of the check-up never appear as individuals. “You remain a statistical face,” says Sroczynski.

A lack of skilled workers makes implementation difficult

Even if prevention from the age of 30 clears all other hurdles, the implementation will be difficult: in the tight schedule of the consultation hours, the general practitioners have to buy additional time for this. Even more serious: “There is a blatant shortage of skilled workers,” said Dr. Friedrich Hüppe from the colorectal carcinoma specialist group in the professional association of resident gastroenterologists during the press conference.

The corona pandemic has also significantly exacerbated the shortage of skilled workers in the field of resident doctors. A shortage of practice staff could make it difficult to carry out the additional examinations.

Nevertheless, it is worth relying on family doctors in this context. As the model project showed, they are excellent motivators. The majority of those examined stated that the advice given by their general practitioner provided the decisive impetus for the intestinal check. It’s just four short questions. Any adenoma that can be removed in this way before it becomes cancerous is worth it.

Free screenings for all high-risk residents of Dubai under the Basmah Scheme

In the UAE ‘The National Guidelines for Colorectal Cancer Screening and Diagnosis’ recommend Colorectal Cancer Screening: means looking for polyps or cancer in the colon and rectum in people who have no symptoms of the disease. Screenings are recommended for both males and females from 40-75 years of age according to certain criteria which can be checked by visiting: UAE Ministry of Health Colorectal Cancer Guidelines 

All HanseMerkur plans are available with cover for annual colorectal cancer screenings, along with other screenings for all the other most prevalent cancers. Moreover, as mandated by law, all residents of Dubai are entitled for free annual colorectal screening, which must be covered by default on any Dubai Health Authority (DHA) compliant insurance policy and consequently paid for by the health insurance companies.