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Colon cancer screening: new recommendation harms women
A few days ago, a new recommendation for colon cancer screening was published in the medical journal "BMJ". The Leibniz Institute for Prevention Research and Epidemiology - BIPS now points out that this directive harms women.
Colon cancer is one of the most common cancers in Germany. According to health experts, many diseases could be prevented if more people would go for regular checkups. At the beginning of October, a new recommendation for colon cancer screening was published in the specialist journal "BMJ". According to the Leibniz Institute for Prevention Research and Epidemiology - BIPS, the key message is that screening is only recommended for people who are at least three percent likely to develop colorectal cancer in the next 15 years. This would discourage the majority of women from screening - although the benefits for them are clearly demonstrated, emphasizes Prof. Dr. Ulrike Haug, head of the clinical epidemiology department at the Leibniz Institute for Prevention Research and Epidemiology - BIPS, in a communication. The expert criticizes not only the recommendation itself, but also the methodology used to create it.
"Should we advise against the majority of all women from screening"
Most current guidelines recommend that colorectal cancer screening be recommended for men and women aged 50 and over, as stated in the communication. According to the information, this takes into account that colon cancer develops very slowly from precursors and the screening prevents disease cases that would only occur much later in life.
The approach of the BMJ recommendation was different. A 22-member panel was asked to assess how large the benefit should be in absolute terms for most people to choose screening. However, only comparatively extreme answer options were offered.
"It is therefore not surprising that the threshold was set relatively high in the end and very restrictive recommendations resulted," explains Haug. If one were to apply this recommendation, the majority of all women would have to be advised against screening and its use would shift overall to higher age groups.
Recommendations could cause great uncertainty
“There is hardly any other cancer that offers early detection options as effective as colorectal cancer. To advise against this, because a small group of experts presumes to be able to judge what the population regards as relevant benefits, seems absurd. In Germany, 45 percent of colorectal cancers occur in women. I think it is not justifiable to advise women against colon cancer screening or to recommend it only at an older age. Even if you can still diagnose colon cancer at an early stage, you reduce the chance of completely preventing the onset of the disease, ”explains Haug.
“Personally, I would much prefer not to get cancer at all, and that's probably how many feel. However, the BMJ expert panel classified the benefits of not getting cancer versus the benefits of not dying cancer as equivalent. There is also another problem. To be able to apply the recommendation, you first have to find out whether the personal risk of developing colon cancer in the next 15 years is below or above three percent. However, the current forecasting models are still very faulty. For example, about two thirds of women who will develop colorectal cancer in the next five years would be wrongly predicted that their risk would be less than three percent - and according to the BMJ recommendation, they would be advised against screening for colorectal cancer, ”says the professor .
"The authors of the study emphasize that the BMJ recommendations are not 'strong recommendations' and that you should make a personal decision in consultation with the doctor. Nevertheless, I am concerned that these recommendations create great uncertainty and, in total, do much more harm than good, especially for women, ”said Haug.
Organized colon cancer screening program
As the Federal Joint Committee (G-BA) reported in an earlier communication, organized colorectal cancer screening in Germany contains the following examination options:
- At the age of 50 to 54 years, women and men can have an immunological test (iFOBT) for occult (not visible) traces of blood in the stool annually.
- From the age of 50, men are entitled to two screening colonoscopies (colonoscopy) at least ten years apart. If the offer is only accepted from the age of 65, you are entitled to an early detection colonoscopy.
- From the age of 55, women are entitled to two screening colonoscopes at least ten years apart. If the offer is only accepted from the age of 65, you are entitled to an early detection colonoscopy.
- From the age of 55, women and men are entitled to an immunological test (iFOBT) every two years, as long as no early detection colonoscopy has been used.
- In the event of conspicuous stool tests, there is a right to a clarification colonoscopy. (ad)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.