Colorectal Cancer Screening: Are we Missing an Opportunity in Trinidad & Tobago?
Main Article Content
Objectives: Opportunistic (ad-hoc) screening for colorectal cancer is practiced in Trinidad & Tobago, but there is no data on the outcomes of opportunistic screening. We carried out this study to determine the proportion of persons with colorectal ancer who were screen-detected.
Methods: We retrospectively audited the records of all patients who underwent colectomies for colorectal cancer at a public hospital over a 10-year period from January 1, 2012 to January 30, 2022. We compared American Joint Committee on Cancer stage based on method of diagnosis (screening vs symptomatic). Descriptive statistical analyses were generated using SPSS version 21.0.
Results: We analyzed 340 patients with colorectal cancer at a mean age of 63.3 years (SD +/- 13.4). There were 52 (15.3%) patients who had diagnoses made at screening and 283 (84.7%) had investigations after developing symptoms. Significantly more screen-detected lesions were early-stage colorectal cancer (73.1% vs 25%; P <0.001). Table 1 compares the cancer stage in both patient groups.
Conclusions: Although significantly more patients with colorectal cancer are diagnosed at early stages by screening, the incidence screen-detected disease in Trinidad & Tobago is low. Most patients present with locally advanced (52%) or metastatic (15%) disease, when the opportunity for curative treatment is reduced. The time has come for policy makers to develop and institute a national screening programme for colorectal cancer in Trinidad & Tobago.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2. Pan American Health Organization. Colorectal Cancer Screening in the Americas: Situation and Challenges. 2016. Available online: https://www.paho.org/hq/dmdocuments/2016/Colorectal-Cancer-Screening-Landscape-English.pdf
3. Griffith S, Padmore G, Phillips E, et al. Colorectal cancer demographics in Barbados. Med Int. 2021;2:1-4.
4. Cawich SO, Phillips E, Moore S, Ramkissoon S, Padmore G, Griffith S. Colorectal cancer in an Eastern Caribbean nation: are we missing an opportunity for secondary prevention? Rev Panam Salud Publica. 2022; 46: e18. https://doi.org/10.26633/ RPSP.2022.18
5. Reinier GS, Peterse EF, Knudsen AB, et al. Optimizing colorectal cancer screening by race and sex: Microsimulation analysis II to inform the American Cancer Society colorectal cancer screening guideline. Cancer. 2018; 124(14): 2974–85.
6. Buskermolen M, Cenin DR, Helsingen LM, et al. Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study. BMJ. 2019; 367: l5383.
7. U.S. Preventive Services Task Force. Colorectal Cancer Screening: Final Recommendation Statement. 2021. [Available online at: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening]
8. Wharfe G, Benson AB, Lurie RH, et al. National Comprehensive Cancer Network. NCCN Harmonized Guidelines for the Caribbean: Colorectal Cancer. 2018; 2 [Available at: www.nccn.org/store/login/login.aspx?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/colon_harmonized-caribbean.pdf]
9. Cawich SO, Mahabir AH, Arthurs M. Clinical yield of screening colonoscopies in Jamaica. Trop Doct. 2022; 52(1): 104-106. doi:10.1177/00494755211039591
10. Bretagnol F, Dedieu A, Zappa M, Guedj N, Ferron M, Panis Y. T4 colorectal cancer: is laparoscopic resection contraindicated? Colorect Dis. 2011; 13: 138–3.
11. Kuhry E, Shwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 2008: CD003432.
12. Masi G, Vasile E, Loupakis F, et al. Randomized trial of two induction chemotherapy regimens in metastatic colorectal cancer: an updated analysis. J Natl Cancer Inst. 2011; 103(1): 21-30.
13. Bonner RM, Ludwig KA. Laparoscopic Colectomy for Colon Cancer: Comparable to Conventional Oncologic Surgery? Clin Colon Rectal Surg. 2005; 18(3): 174–181
14. Biondi, A., Grosso, G., Mistretta, A. et al. Laparoscopic vs. open approach for colorectal cancer: evolution over time of minimal invasive surgery. BMC Surg. 2013; 13(S2):1-5
15. Huang, YM., Lee, YW., Huang, YJ. et al. Comparison of clinical outcomes between laparoscopic and open surgery for left-sided colon cancer: a nationwide population-based study. Sci Rep. 2020; 10: 75-77.
16. Leake PA, Pitzul K, Roberts PO, Plummer JM. Comparative analysis of open and laparoscopic colectomy for malignancy in a developing country. World J Gastrointest Surg. 2013; 5(11): 294-299.
17. Plummer JM, Mitchell DIG, Arthurs M, et al. Laparoscopic colectomy for colonic neoplasms in a developing country. Int J Surg. 2011; 9(5): 382-5.
18. Cawich SO, Singh Y, Naraynsingh V, Senasi R, Arulampalam T. Freehand-robot-assisted laparoscopic colorectal surgery: Initial experience in the Trinidad and Tobago. World J Surg Proced. 2022; 12(1): 1-7
19. Ascanelli S, Navarra G, Tonini G, et al. Early and Late Outcome after Surgery for Colorectal Cancer Elective versus Emergency Surgery. Tumori J. 2003; 89(1): 36–41.
20. Redaelli A, Cranor CW, Okano GJ, Reese PR. Screening, prevention and socioeconomic costs associated with the treatment of colorectal cancer. Pharmacoeconomics. 2003; 21: 1213-38.
21. Chen TM, Huang YT, Wang GC. Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Oncol. 2017; 15: 164.