Scary numbers: in a year – due to the pandemic – more than 1 million and 110 thousand screening tests for colorectal cancer have been skipped. In total, 1,300 fewer cases of cancer and -7,400 advanced adenomas were identified. A situation that risks presenting a high toll in the coming years with late diagnoses and more difficult cases to treat. For this reason, the specialists of the Italian Association of Medical Oncology (Aiom) launch an appeal for the screening programs to be relaunched and also expanded and kick off the Diagnostic Tests in Colorectal Cancer project carried out thanks to the unconditional support of Pierre Fabre. .
Why screening is so important
Screening against this form of cancer is essential to find the diagnosis as soon as possible. For 89% of specialists, the examination for the detection of occult blood in the faeces should be extended up to 74 years (currently it is foreseen for the age group 50-69 years). Cancer affects more than 43,700 men and women every year in Italy and of these cases about 10,000 are metastatic. “From 2013 to today – he says Giordano Beretta, Aiom national president – the incidence of the disease has dropped by 20% thanks above all to screening programs that allow early diagnosis. Covid-19 may have compromised this good result and therefore we reiterate, for the umpteenth time, the need to relaunch secondary cancer prevention campaigns. Colorectal cancer is in fact a very widespread cancer which causes more than 21,000 deaths every year in Italy ”.
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The molecular test
Another element to consider is that it is an extremely heterogeneous disease from the genetic-molecular point of view and therefore to defeat it it is necessary to define what is the characterization of the molecular biology of each individual case. “In this way 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 would allow important savings for the coffers of the national health system ”, adds Beretta.
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The diagnostic test project
The aim of the Aiom project is to provide 360 ° information and culture on the pathology and above all on the use of some exams for the personalization of treatments. It includes a survey conducted among Aiom members, a brochure dedicated to patients and caregivers, webinars for specialists and activities on the main social media. “Our survey shows that nine out of ten oncologists assess the mutational status of BRAF V600 before undertaking first-line treatment for metastatic colorectal cancer. This mutation is present in 10% of patients – he continues Saverio Cinieri, president-elect Aiom. It can provide valuable prognostic information and give us indications on 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 “.
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Tailor-made therapies
The use of the molecular test is therefore also used to select the therapy for those with an advanced disease. “Some recent scientific studies – adds Cinieri – have highlighted the high activity of a combination including Cetuximab and Encorafenib in patients with BRAF mutation progressing 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 mostly due to logistical, organizational or administrative problems. More than 70% of oncologists then declare that they work in health facilities where molecular biology / pathological anatomy laboratories capable of performing molecular tests are active. These examinations must always be guaranteed for all patients and throughout the national territory also by exploiting, where they are available, the paths of the Regional Oncological Networks “.
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The role of the general practitioner
Colorectal cancer is the second most frequent in our country where 513,000 patients with this neoplasm live, mainly over sixty years old and with the need to undergo treatments and examinations for long periods of time. “The role of the general practitioner in assisting such an imposing number of patients appears to be fundamental – continues Beretta -. However, again according to our survey, 24% of oncologists consider collaboration with this professional figure to be poor. It is an aspect on which we must work by raising the awareness of family doctors on how to help the client in the side effects of therapies or in follow-up checks. The fight against cancer must provide for an ever greater integration between hospital specialists and local medicine ”.
The problem of therapeutic adherence
Collaboration is even more necessary also because the use of oral drugs is growing even in metastatic colorectal cancer. “This raises the problem – concludes Cinieri – of therapeutic adherence which, according to 48% of specialists, is favored by oral administration. However, it should be remembered that the cancer patient is often frail, elderly, with comorbidities and forced to take several therapies at the same time. The family doctor can and must play a valuable role in the management of possible interferences, side effects as well as in adherence to treatments.
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