Focus on bowel cancer screening

In the USA, the US Preventive Services Task Force has come out with a recommendation for earlier bowel cancer screening from the age of 45. According to the study, the risk of severe to fatal colorectal cancer increases significantly, which clearly underlines the sense of screening for colorectal cancer before the age of 50. Accordingly, not only patients at risk, for example those with obesity, but also other groups are affected.

In the wake of the COVID19 pandemic, the problem of unnoticed regular screening is intensifying, which is likely to develop as a time bomb with a fuse of up to ten years.

The specialists of Swiss1Chirurgie and the Gastroenterological Group Practice GGP Bern point out the importance and great benefit of regular preventive examinations. In view of the developments in the USA and beyond, this should not only become more of a focus for people over 50, but also open up the discussion for universal pension provision from the age of 45 in Switzerland. The counselling service offered by Swiss1Chirurgie and the Gastroenterology Group Practice GGP takes this topic extremely seriously and provides important information on bowel cancer screening.

Read more about the recommendation of the US Preventive Services Task Force and the position of Swiss1Chirurgie and the Gastroenterological Group Practice GGP in the detailed article.

“This is a time bomb with a ten-year fuse”.

The US Preventive Services Task Force recommends colorectal cancer screening starting at 45

When the US news channel CNN reports in detail, it is on issues with implications. This is also the case in a report dated 18 May 2021, which deals in detail with the recommendation of bowel cancer screening from the age of 45.

Until now, at least in the USA, screening for colorectal cancer was recommended from the age of 50. If one follows the research results and the statements of renowned medical specialists on the subject, then bowel cancer diseases are reaching more and more people, including younger people. Accordingly, the lowering of the recommended age was only a question of common sense and forward-looking care.

The US Preventive Services Task Force is the leading advisory body on medical issues in the US and had already presented the draft of this recommendation in October 2020. The final version now available suggests that all people aged 45 to 75 years should be screened for colorectal cancer.

The reasoning

In a detailed justification, the makers of the recommendation explain that with colorectal cancer screening from the age of 50, about 50 cases in a number of 1,000 persons could be detected and avoided and, in addition, 25 deaths could be prevented.

Lowering the recommended age for colorectal cancer screening from 50 to 45 could effectively achieve two to three more cases of colorectal cancer and at least one death over and above the numbers achieved so far, he said.

This is the assumption of Dr Michael Barry, who, as vice-chairman of the US Preventive Services Task Force, has spoken to CNN on the subject.

Bowel cancer is the third most common cause of cancer deaths

This is true at least for the USA, but is also likely to be the case internationally. If you follow the figures in the USA, it is predicted that around 53,000 people will die of colorectal cancer in 2021, and the trend is rising. It is noteworthy that about 10.5 percent of newly diagnosed colorectal cancers occur in people under the age of 50. In the first 15 years since the turn of the millennium, cases have increased by a worrying 15 percent among adults aged 40-49. This, too, puts the US Preventive Services Task Force on alert to focus carefully on colorectal cancer at an earlier age.

Whereas colorectal cancer was previously mainly observed as a result of the risk factor obesity, the intestinal disease is increasingly affecting people who do not have such risk factors. Dr Benjamin Lebwohl, a gastroenterologist at NewYork-Presbyterian and Columbia University Medical Center, confirms this when he tells CNN: “To some degree, it can be driven in part by obesity, but there are many people younger than 50 who are not obese who develop colorectal cancer without any identifiable risk factors.”

American scientists and doctors have not yet been able to clearly define why cases of colorectal cancer are now also increasing in the age groups under 50. What is certain, however, is that cases can also be detected much earlier and treated more effectively through earlier screening.

The time bomb is ticking

What comes across here as an ominous scenario is justified when one takes a closer look at the figures. In 2018 alone, about 31 percent of eligible people in the US were not up to date on their colorectal cancer screening.

This number is likely to increase even further in the context of the Corona pandemic, as many adults are skipping the necessary screening examinations out of uncertainty, especially in the current phase. This is just as true in the USA as it is in Europe and Switzerland.

If one follows the opinion of Dr Michael Zinner, CEO and senior medical director of Baptist Health’s Miami Cancer Institute, it could be that “delayed screening due to Covid is a ticking time bomb with a ten-year fuse”.

Accordingly, doctors are increasingly urging their patients to catch up on bowel cancer screening examinations that they have not attended. The emphasis is that any test that has been done is always better than a test that has not been done.

Conclusions from the perspective of Swiss1Chirurgie and the GGP Bern

From the point of view of Swiss1Chirurgie and the Gastroenterology Group Practice GGP, bowel cancer screening has been the best and safest means of detecting and treating bowel cancer in good time for decades. Accordingly, attention should be paid to preventive examinations.

In Switzerland, too, this affects not only older women and men, not only people with certain risk factors such as obesity or a genetic predisposition, but practically every adult. From middle age at the latest, people should actively address this issue and talk about it with their family doctor or a specialist.

Although many developments from the USA only arrive in Europe and Switzerland with a certain delay, great vigilance must be maintained, especially in the case of colorectal cancer. To continue to wait here would allow the aforementioned time bomb to continue ticking and lay the extended fuse in this country as well.

The clear call is therefore to take advantage of the opportunities for bowel cancer screening in any case. And they do so regularly and even when there are individual concerns, such as during the COVID19 pandemic.

In Switzerland, the recommendation is still to have a colonoscopy as a preventive examination from the age of 50. However, this does not apply to patients with stool irregularities, blood in the stool, chronic abdominal pain, or alternating diarrhoea and constipation, or relatives who have already had bowel cancer. If necessary, these patients should have a colonoscopy at an earlier stage so that changes can be diagnosed and treated in time.

The original CNN article on the subject can be found at Colorectal cancer: US task force lowers recommended age to start cancer screening to 45 – CNN

Appendicitis

Why quick surgery is better than antibiotics alone

It is hard to believe: In the last two decades, great efforts have been made to prove that antibiotic therapy is better than laparoscopic (minimally invasive) surgery for mild appendicitis.

What is the appendix? When does appendicitis occur?

The appendix is a more or less pointless appendix on the large intestine in the right lower abdomen. It is between 5-10 centimetres long, about one centimetre wide and can become inflamed at any time. The reasons for infection are always debated. The fact is that appendicitis can occur in early childhood as well as in old age, practically at any time.

How do you notice an appendicitis?

It usually starts with diffuse abdominal pain and loss of appetite, sometimes nausea and vomiting. The pain then moves to the right lower abdomen. Later, fever and a rapid pulse may also occur.

It is important to go to a hospital emergency quickly. If the clinical examination by the doctor is clear and the situation is urgent, surgery may be performed immediately. However, an ultrasound scan or computer tomography is often performed to confirm the diagnosis or to exclude other causes for the abdominal pain.

How we treat appendicitis in the swiss1chirurgie clinic

Rapid surgery is the best therapy! This is also confirmed by a study just published in October 2018 in the well-known journal “Surgery”. The study uses a large American database to describe the safety of a rapid laparoscopic appendectomy (appendectomy, through three small incisions with minimally invasive instruments). This solves the problem once and for all. Antibiotic therapy alone in uncomplicated appendicitis (i.e. only mild infection) is often advocated, but the initial success rate is at most 75%. The risk of having another infection afterwards is almost 20%.

Antibiotics are therefore only given directly before the operation and are only necessary after an operation if the appendix had already broken through (perforation, pus discharge, abscess). Antibiotic therapy for 5-7 days is then necessary, possibly even with inpatient intravenous administration.

More about the swiss1chirurgie clinic, appendicitis and other of our focal points at www.drzehetner.ch. You can find out more about the Centre for Bariatric Surgery at www.zfbc.ch.

Diverticulitis

Dietary tips for large bowel obstruction and colitis

The colon is part of the digestive system and reabsorbs water and electrolytes through the colon mucosa. In addition, the large intestine fends off diseases and bacteria and also functions as a storage facility for stool. Colitis (inflammation of the colon) is an inflammatory process that can be acute or chronic. One of the most common forms of colitis is the widespread and well-known appendicitis.

Diverticulitis should be distinguished from such acute inflammatory processes. Diverticulitis describes chronic infections of mucosal protrusions as a chronic process with recurring symptoms.

In connection with diverticulitis, questions are repeatedly asked about a diet that suits the disease. It must also be taken into account that diverticulitis is a typical disease in Western civil societies and is practically not observed at all in Asia or Africa. Accordingly, it can be assumed that one of the main causes of the disease patterns is to be found in lifestyle and diet. In this context, it is also interesting that long-time vegetarians are significantly less affected.

Diet in the acute stage of diverticulitis

In the acute course of diverticulitis, one or more diverticula (protrusions of the intestinal mucosa) are usually infected. Typical symptoms are pain in the left lower abdomen, fever and increased inflammation values in the laboratory test. In case of such manifestations, the family doctor should be consulted urgently, who may also prescribe hospital care, antibiotic medication and a sparing diet. In an extreme emergency, surgery must be performed immediately, especially if fever and an unstable circulation are accompanied by the typical pain.

If no surgery is required acutely, special attention must be paid to nutrition in the acute stage of diverticulitis. It is advisable to completely avoid solid food for a few days. Liquid food and sparing food are compulsory and can be gradually built up to a light sparing food under individual nutritional counselling.

A diet plan in the sequence could then look something like this: Start with water, continue with tea and rusks, clear soups, creamy soups and yoghurt. This sequence is spread over a time frame of several days and must be set individually.

In the phase of the build-up diet, it is imperative to avoid fatty, spicy or flatulent foods in order not to further irritate the intestines. As soon as intestinal activity returns to normal, other foods can gradually be reintroduced into the diet.

A change in diet is recommended after diverticulitis

The top recommendation is: Change your diet to a high-fibre diet, similar to diverticular prophylaxis, even after an infection. In this way, you prevent a new inflammatory episode and also prevent a new diverticulum formation through a softer and more voluminous stool.

It is important when changing to a high-source diet that you also drink enough now. Water and tea are preferable.

In summary, we would like to give the following tips on dietary changes after diverticulitis:

• Eat plenty of fruit and vegetables. Important are the vegetable fibres and high water content.
• Drink a lot! Dietary fibre is only helpful if you drink at least two litres of water or tea in parallel.
• Prefer vegetables of the easily digestible variety such as tomatoes, carrots and courgettes.
• Wholemeal bread and wholemeal pasta are more suitable for diverticulitis nutrition than white bread.
• If you have diverticulosis, you should avoid hard, pointed and hard-to-digest food components, such as the seeds of apples, pears or melons.
• Wheat or oat bran and ground linseed are also good. Avoid constipating foods such as black tea, chocolate, cocoa, bananas and white flour products.

Allow time for the change to a diet rich in fibre and source material. And above all, stay consistent.