Monique van Leerdam, leading colorectal cancer expert and member of the United European Gastroenterology Public Affairs Committee, discusses what action can be taken to reduce the heavy burden of colorectal cancer across Europe.

Colorectal cancer (CRC) is Europe’s second biggest cancer killer, claiming the lives of over 170,000 people in the EU each year. (1) Accounting for 13 per cent of all cancers – with over 375,000 newly-diagnosed cases annually – CRC is the most common digestive cancer.

This year marks 10 years since the European Parliament adopted the Written Declaration on Fighting Colorectal Cancer in the European Union, which called upon the EU and Member States to improve public awareness and policies to tackle the CRC burden across Europe. CRC screening, which has been shown to reduce mortality rates, was a key focus of the Written Declaration, with calls to encourage the implementation of CRC screening best practice in all EU countries.

 Since 2010, the number of countries that have implemented CRC screening has increased from 15-to-23, targeting 72 per cent of the eligible European population. (3)

 Although clear progress has been made in the implementation of CRC screening programmes across the EU, there are still vast discrepancies between Member States in the quality and cover of their national programmes.

The Importance of CRC Screening

Detecting CRC at an early stage is vital in improving survival rates. CRC patients have a five-year survival rate of 92 per cent when detected at stage one and an 84 per cent survival rate at stage two, while dropping down to 65 per cent when detected at stage three, and even further at stage four with a survival rate of just 10 per cent. (6) This demonstrates that the vast majority of patients can be cured if they receive an early diagnosis.

Since the roll-out of screening programmes, Europe has observed a steady decline in CRC mortality rates and a recent global study published in The Lancet has demonstrated a correlation between the introduction of screening programmes and a reduction in mortality.

While the UK and Ireland have CRC screening programmes, implementing a screening programme in the first place is not the only issue. The inequality in eligible citizens participating in screening is vast across Europe, including in the UK and Ireland. For example, there are 54 per cent, 55 per cent, 55 per cent and 63 per cent participation rates in Northern Ireland, Wales, England and Scotland respectively, but in Ireland participation rates are as low as 12 per cent. Governments should therefore address the organisation of screening programmes to encourage improved participation rates in eligible citizens.

Improving Public Awareness

As well as improvements in CRC screening, we need to support and encourage public awareness campaigns and public health interventions in the EU that facilitate positive lifestyle changes to reduce the risk of CRC.

Nine-in-10 people, for example, are unaware that alcohol increases the risk of cancer. Consuming just one alcoholic drink per day increases the lifetime risk of CRC and it is therefore advised to avoid heavy alcohol consumption to reduce the risk of CRC. (4) In addition to the risks associated with alcohol, CRC is linked to inactive lifestyles, poor diets and obesity. (5) CRC rates in young adults is increasing by six per cent per year, which could be linked to these unhealthy habits and sedentary lifestyles. Research has found that up to 28 per cent of CRC cases in the UK are caused by eating too little fibre, while five per cent is caused by too little physical activity. (7) It has been suggested that lifestyle changes, such as a high fibre diet, reducing the intake of red meat, and maintaining a healthy weight, while keeping active, aids the limit of colorectal cancer.

Raising public awareness that addresses healthy lifestyles is therefore a key measure action in minimising the threat of colorectal cancer.

Positive actions include the introduction of policies that limit the consumption of fast foods, implementing incentives to reduce the production of processed foods, and facilitating educational programmes that highlight the risk of smoking, high alcohol consumption and processed foods.

Knowing the key symptoms of CRC is also a key factor helping to achieve an earlier diagnosis. These include a change in bowel habits, blood in stools, or unexpected weight loss, and patients should seek advice from their doctor should they notice any of these changes. Healthcare professionals must act as proactive figures by educating citizens of CRC symptoms to help contribute to early detection of this disease.

Summary

The most crucial and effective component in the battle against colorectal cancer is to recognise its presence as early as possible.       

Increasing the implementation and quality of CRC screening programmes needs to become a key priority for governments across Europe, as well as improving public awareness of the key symptoms and risk factors.

For more information, read the United European Gastroenterology’s ‘Co-ordinating European Action on Colorectal Cancer’ manifesto.

References

1. European Parliament. (2010). Written declaration on fighting colorectal cancer in the European Union.  Available at: www.europarl.europa.eu/sides/getDoc.do?pubRef=-// EP//NONSGML+WDECL+P7-DCL-2010-0068+0+DOC+PDF+V0//EN&language=EN

2. Gut. (2019). Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Available at: www.gut.bmj.com/content/68/10/1820

3. European Commission. (2018). ECIS- European Cancer Information System. Available at: www.ecis.jrc.ec.europa.eu/explorer.php?$0-0$1-AE28$4-1,2$3-All$6-0,14$5-2008,2008$78$CEstByCancer$X0_8-3$CEstRelativeCanc$X1_8-3$X1_9-AE28

4. Alcohol and digestive cancers across Europe: time for change. Available at: www.ueg.eu/publications/alcohol-and-digestive-cancers-report/

5. United European Gastroenterology. 2018. European colorectal cancer rates in young adults increasing by 6% per year. (ONLINE). Available at: www.ueg.eu/press/releases/ueg-press-release/article/ueg-week-european-colorectal-cancer-rates-in-young-adults-increasing-by-6-per-year/

6. Bowel cancer survival statistics. Available at: www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/survival#heading-Three

7. Cancer research, bowel cancer survival statics. Available at: www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/survival