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Health IN, Cancer OUT - Regular Cancer Screening for Timely Cancer detection

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  • Modify Date:Modify Date:2021/11/26
  • Publish Date:Publish Date:2021/08/26

In 2021, with the COVID-19 pandemic and the mandated reduction of hospital capacity for ordinary healthcare services, the willingness of the public to seek medical care was largely affected. As a result, the number of participants for cancer screenings remarkably decreased in recent months. At the end of July 2021, a total of 2.4 million people participated in four cancer screening programs (breast, cervical, colorectal and oral cancers), about a 10% decrease compared with the corresponding figures in July 2020. Director-General Wu Chao-chun (吳昭軍) of Taiwan's Health Promotion Administration (HPA), reminds the public to get regular cancer screening. While the pandemic is gradually slowing down now and health services are returning to their original capacity, Wu encourages the public to safeguard their own health, at the same time following CECC’s Covid-19 control measures. If the cancer screening results are abnormal, please follow the doctors’ advice for further confirmation. Early diagnosis and treatment for cancers will bring better results.

Colorectal cancer topped the list of the most common cancers for 13 years, and the incidence rate in men are 1.5 times more than women.

Regarding the WHO’s recommended screening for four types of cancer: breast, colorectal, cervical, and oral, studies have shown that screening tests can save lives by diagnosing cancer early. Take colorectal cancer as an example; the number of confirmed colorectal cancer cases remains the highest in 13 consecutive years in Taiwan. Every year, more than 15,000 new colorectal cancer cases are diagnosed, with a median age of 66. Colorectal cancer is the most common cancer for men, the third for women, with the incidence rate 1.5 times higher in the former, therefore men should pay special attention to this. According to the data analysis of HPA in 2020, the number of men undergoing coloretcancer screening (525,000) was much lower than that of women(718,000), given higher risk in men. With such a low rate of  screening participation, less number of adenomatous polyps were detected, resulting in a higher future risk of colorectal cancer. The HPA provides the fecal immunochemical test (FIT) every two years for people with no symptoms aged 50 to 74 years. FIT is a non-invasive screening test, detecting blood in the stool with high accuracy and without the need for dietary restriction. People who were born between 1947 and 1971 are encouraged to take their National Health Insurance (NHI) card to nearby NHI-contracted hospitals or clinics to pick up the FIT kit. Stool sampling using the kit can be easily done at home, and return the kits to the hospitals or clinics for examination.

 

10,000 colorectal adenoma cases and 1000 colorectal cancer cases are yet to be discovered.

According to data from the Taiwan Colorectal Cancer Screening Program, among subjects with a positive FIT, half of them had colorectal adenomas, and 1/20 of them had colorectal cancer. In 2021, due to the impacts of COVID-19, many people with positive FIT results postponed their colonoscopy because of fear of being infected during hospital visit. At the end of July, about 20,000 FIT positive cases have yet to undergo colonoscopy examination. That being said, there are potentially 10,000 cases of colorectal adenoma cases and 1,000 colorectal cancer cases, with half of them being early-stage ones, remain to be diagnosed. The HPA further calls for attention that FIT-positive people are at higher risk of colorectal adenoma and cancers and should undergo colonoscopy as soon as possible. If an adenoma is detected, it can be removed at the same time to prevent the progression of precancerous lesion to cancer.

 

The risk of advance colorectal cancer doubles if colonoscopy is completed more than 6 months after positive FIT test.

Should FIT-positive subjects be recommended to repeat FIT instead of going for colonoscopy? According to research data, if FIT-positive subjects delayed colonoscopy completion for 6 months or more, the risk of being diagnosed as advanced stage colorectal cancer would increase by 2-fold; if colonoscopy was postponed for 12 months or longer, then such risk increases even higher to 2.8-fold. Dr. Han-Mo Chiu, Secretary-General of the Gastroenterological Society of Taiwan and Director of Health Management Center at the National Taiwan University Hospital, also indicates that with the pandemic now slowing down and hospitals adopting adequate pandemic control measurements, FIT-positive subjects should undergo colonoscopy as soon as possible to lower the risk of colorectal cancer.

 

Eight steps to collect stool samples for fast FIT tests

The HPA subsidizes one FIT test every two years for people aged 50 to 74 years. FIT is a non-invasive test without causing any pain or requiring any diet restriction. There are 8 simple steps to correctly collect samples for the test. Eligible residents may take their NHI cards to the nearby hospitals or medical institutions and pick up their FIT kits for free. Fecal samples may be collected with the stick and then be returned back to the hospitals or medical institutions for examination. According to data of our screening program, the biannual FIT screening significantly decreased colorectal cancer death by 35% and lowered the incidence of advanced stage colorectal cancer (stage II/III/IV) by 29%. The 5-year survival rate of early stage colorectal cancers is estimated at 90% or higher, while the 5-year survival rate of stage IV colorectal cancer is only 14%, demonstrating the importance of early diagnosis. The HPA wishes to remind everyone that if you are eligible for colorectal cancer screenings, please go to the nearest NHI-contracted medical institution to pick up your test kit, as early detection of cancer can lead to better treatment outcomes.