Abstract
Colorectal Cancer Screening: Asian Perspective
Dr Taya Kitiyakara
Gastroenterology Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Colorectal cancer is the second leading cause of death from cancer in the West. Evidence suggests that its incidence is increasing in Asia where increasingly Westernisation of diet and lifestyle is occurring in many countries. Its traditional natural history (of progression from polyps to cancer) makes it suitable for screening programmes for the general population. Many screening modalities have been proposed and population pilot studies have been performed, mainly in the West.
The optimum screening modality is as yet undetermined and benefits/disadvantages of screening, for example, with faecal occult blood tests, colonoscopy and CT colonography are discussed. There may be a significant difference between the aims of a National screening programme and private individual screening where funding come from different parties. Cost effectiveness may be more of a concern for national programmes whilst completeness and peace of mind may be the priority in private screening. However no matter the initial screening modality, colonoscopy is required as the back-up procedure in all cases. As these colonoscopies will be performed, perhaps recurrently, on asymptomatic patients, it is crucial that quality assurance is maintained.
There is a growing consensus that there should be screening programmes in Asia. However, wide differences exist between countries in Asia, in terms of resources, geography, health care systems and patient awareness and education. Each country will need to develop its own screening programme appropriate to these factors. Strategies that are cheaper and put less burden on scarce resources would perhaps be preferred in less developed countries. Much research is still needed to adapt these possible screening strategies to many countries in Asia.
