Le dépistage, un geste simple. Midi Libre – ANNESI TIZIANA
“Ok mom, I'll quit smoking and you, you get your colorectal screening”: faced with the very poor figures for colorectal cancer screening in Occitanie, barely one in three people between 50 and 74 years old, Health Insurance is initiating a new regional awareness campaign, focused on the intergenerational link.
Emmanuelle Samalin is a hepato-gastroenterologist at the ICM Val d’Aurelle in Montpellier, specializing in medical oncology.
For Emmanuelle Samalin, the eligible population must be screened. Midi Libre – JEAN MICHEL MART
Why is there so little adherence to colorectal cancer screening ?
For fear of a positive result, I think, and because this test requires examining stools, it remains complicated even though there is nothing difficult to do, it is not dirty. Breast cancer screening is easier.
Maybe we are also bad, that we do not communicate enough, even if I have the impression that we have been going all out in recent years.
It should be remembered that this screening is for the general population, that is to say people who are asymptomatic, without any identified risk factors. There is very little chance of discovering cancer.
For screening to have value, there must be at least 45% participation, we are well below.
The new screening invitation campaign. DR
Barely 30%…
In France, it’s 38%, in Hérault, it’s 34%. It’s still better if we can anticipate, because colorectal cancer is the second most deadly cancer.
With what results ?
In 96% of cases, the screening result is normal. When the test is positive, there is a 5 out of 10 chance that there is nothing at all in the colonoscopy, a three to four out of 10 chance that there is a benign polyp and a one in 10 risk of finding cancer. And in this case, this cancer will be cured in 90% of cases.
It is still extremely reassuring to think that we can detect early, that is the interest of screening!
By definition, when we go for screening, we take the risk that the result will be positive. What needs to change in our minds is that we give ourselves the chance of early detection, and therefore of a cure. If we “bury our heads in the sand” and wait for symptoms, it may be too late.
200% Deposit Bonus up to €3,000 180% First Deposit Bonus up to $20,000“We need public messengers, celebrities”
There is much better around us, in Europe ?
There may be European countries where things are better organized, in registers, population studies… in Sweden, for example. But we can still say that things are improving in France. For five years, the participation rate has been increasing but we really need to do better. 50-74 years old, that's “the” target, that's when the population is most affected. It really needs to get into people's minds and maybe we need public messengers, celebrities…
As soon as a public figure takes up a question that is of a private nature, things seem simpler, more human, we touch people. When it is a doctor, or someone who represents the law, the authority, it is more complicated.
What is the process: test, then if positive, colonoscopy, and if there are polyps, they must be removed during the procedure, and treatment initiated if cancer ?
Exactly. Polyps are often removed during endoscopy. If they are too big or if there is a cancerous transformation, it will be surgery instead… having taken care to eliminate the metastases.
After this surgical procedure, either there is monitoring, if there is no lymph node involvement or risk of recurrence, or we offer a treatment that is called adjuvant, chemotherapy, to secure the situation
In these curative cancer situations, there are specificities, depending on whether we have a tumor located in the colon or the rectum. For the colon, we tend to do surgery, and then treatment if the lymph nodes are positive. For the rectum, there will be a lot of treatments before surgery, radiotherapy, chemotherapy, etc. and we have a very small population of patients, which will represent perhaps 15% of colorectal cancers, who will be eligible for immunotherapy. It is not a routine treatment, but we have the possibility of sparing patients a surgical procedure.
We can thus have patients in complete remission.
It is recent ?
Yes, very encouraging studies have been coming out for two or three years, but this remains in the realm of therapeutic trials and clinical research.
On the other hand, it is authorized for metastatic cancers, and we also have complete remissions. There is hope, and it is our role to transmit it, because there is always this collective unconscious of the word cancer associated with death. We heal. We do not want to communicate fear.
A cancer cured nine times out of ten if it is detected early. Midi Libre – SOPHIE WAUQUIER
“There are colorectal cancers”
Once again, it is through immunotherapy that a lot of progress is coming…
Yes, and new targeted therapies, based on the molecular profile of patients, allow us to do personalized medicine with a chemotherapy base.
There is a lot of progress. We even have innovative diagnostic techniques like circulating tumor DNA that allows us to have a molecular profile through a blood test. All this is happening very quickly, even if in practice it is still anecdotal.
You say that there are colorectal cancers…
There are so many different situations that it is complicated to make generalizations. There are colorectal cancers, depending on the situation, the stage, and the molecular abnormalities.
Consultations are sometimes complicated because patients have inquired about the latest therapy, the one that is most talked about. There can be disappointment when we are simply trying to adapt as best we can to the pathology.
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