Colorectal cancer is one of the most common types of cancer in Belgium. In men, it is the third most frequently occurring cancer; in women it is the second most, according to the national cancer register. Colon cancer ranks number two in terms of mortality after lung cancer.1 Doctor Sandrine Roland works as a gastroenterologist and digestive oncologist at the Chirec hospital in Brussels and she is involved in an extensive screening program that is meant to detect colon cancer at an early stage.
“Colon cancer is usually diagnosed at a very late stage, which partly explains the high mortality”, dr. Roland comments. “That is why screening programs have been put in place in Belgium. Colon cancer is a ‘silent’ cancer: during its early stages the patient hardly notices any symptoms. But if colon cancer is detected at such an early stage, nine out of ten patients can be cured.”
In Belgium, screening is offered to people between 50 and 74 years old with an average risk of contracting bowel cancer, meaning having no symptoms and also having a cancer-free past. The screening programme consists of two tiers, the first of which is a fecal examination, where people provide a stool sample for lab testing. Dr. Roland explains: “In this test we look for the presence of hemoglobin within the stool sample. If this test is positive we invite the patient for the second stage of the screening: a colonoscopy. Patients with an elevated risk of colon cancer – e.g. people with a personal or familial history of colorectal cancer or adenoma or chronic inflammation of the digestive tract – and patients with a high risk, such as those with a familial history of congenital colorectal cancer, are subjected to colonoscopies at regular intervals. Colorectal cancers are in 90 percent of all cases purely somatic, but in 10 percent of cases a congenital mutation occurs, as is the case with the Lynch syndrome. People in the high-risk group are already invited for a colonoscopy from the age of 20 and they will have to undergo this examination every two years.”
“It is true that a colonoscopy has the reputation of being an unpleasant, invasive procedure”, dr. Roland explains. “But at the Chirec hospitals we aim to perform these tests with a minimum of discomfort. We offer patients two options: either to undergo full anesthesia, in the presence of an anesthesiologist, or to have the procedure done in an outpatient setting under a local anesthetic. In the latter scenario, a colonoscopy can take as little as 45 minutes and it can be done in a screening centre, instead of a general hospital. Of course, a colonoscopy does come with preparations, such as having a special low-fibre diet in order to cleanse the bowels before the colonoscopy.” A colonoscopy is the only examination where a doctor can be 100 percent certain of detecting colon cancer by the shape of precancerous polyps. Frequently, these polyps can be removed during the colonoscopy. “We use a special kind of ‘lassoo’ that is introduced along with the colonoscopy, that cuts the polyp off and cauterizes the wound. This has often been done with patients who had not suffered a single symptom of colon cancer yet. They are very surprised to learn that they had the beginning stage of cancer and are of course also very relieved that we could remove these polyps. “A colonoscopy may be a daunting prospect, but it is always better to prevent a cancer than to heal one,” says dr. Roland.
In Belgium, the screening programme for detecting colon cancer is done differently in each of the three regions, leading to differences in participation. Dr. Roland explains: “In Flanders there are more people who let themselves get tested than in the capital region or in Wallonia. The difference is that in Flanders, as in the Netherlands, people over 55 can send off their stool sample in the mail.* In the French-speaking part of Belgium, people can already get tested at 50, but they have to deliver the sample at their GP and in Brussels it’s the pharmacies that distribute the tests and collect the samples.”
Flanders, Brussels and Wallonia each have their own colon screening programmes
Dr. Roland hopes that more and more people will understand the benefits from joining in the colon screening program. “We need to get the message across, also in the media, that early screening saves lives. I hope that the systematic screening for colon cancer will become just as widespread and normal as the screening for breast cancer in women.”