Third cause of death in Poland. One test reduces risk by 50 percent.
- The annual number of new diagnoses of colorectal cancer is over 18,000, and the annual number of deaths due to it is almost 12,000. As many as 2/3 of patients are diagnosed in stage III or IV.
- According to experts, screening colonoscopy currently offered by the National Health Fund is not a colon cancer prevention program - such a program must meet international guidelines
- It stopped meeting these requirements in 2021, when the financing was transferred to the National Health Fund. The program was decentralized, and central quality coordination was removed.
- Experts are also concerned about the fact that the FIT test in the Moje Zdrowie program operates separately from the centrally managed program.
- Cancers of the digestive system are currently, apart from lung cancer, the biggest epidemiological problem, which concerns both women and men. The most common of these cancers is colon cancer, which is the third cause of death in both sexes. In Poland, 2/3 of patients with colon cancer are diagnosed late, when the cancer is in the third or fourth stage of advancement - said Prof. Piotr Rutkowski , chairman of the Polish Oncological Society during a debate organized by the PTO.
Let us recall. Every year, over 30 thousand new cases of cancer of the digestive tract are diagnosed in Poland: pancreas, liver, gallbladder, colon, stomach, esophagus. Each year also brings over 25 thousand deaths due to them. In turn, the annual number of new diagnoses of colon cancer is over 18 thousand , and the annual number of deaths due to it is approaching 12 thousand.
In terms of prevention, there is a nationwide colon screening program for people aged 50 to 65, or 40 to 49 if their closest relatives have had this cancer. According to data from the National Health Fund, in 2023, over 65,000 people underwent colonoscopy screening (the value of services was PLN 78 million), and in 2024 – 86,000 people (the value of services - PLN 115 million).
Since May this year, the Moje Zdrowie program has also been launched – an adult health assessment. One of the tests available to patients over 50 years of age under this program is the FIT-OC test for occult blood in the stool.
As Dr. Nastazja Pilonis from the Department of Oncological Gastroenterology of the National Institute of Oncology in Warsaw emphasized during the debate, a screening program is fully justified in the case of colon cancer.
- Colonoscopy detects polyps - pre-cancerous stages that can develop into invasive cancer over the years. During colonoscopy, cancer in a very early stage, without other risk factors, can also be treated endoscopically. A person undergoing colonoscopy therefore has a chance to prevent the disease by detecting early pre-cancerous conditions and removing these changes - explained the specialist.
- If the rate of screening colonoscopy in Poland was the same as in the Netherlands, i.e. at 60-70% , we could detect 50% of colon cancers at a very early stage, with the therapeutic options mentioned above - she added.
As she noted, thanks to randomized studies, it is also known that undergoing a screening colonoscopy can reduce the risk of developing cancer by 50 percent . Comparing this effectiveness to the effectiveness of other preventive measures shows that this is an excellent result, placing colonoscopy in second place, right after vaccinations, among preventive measures.
- It is worth recalling that before the pandemic, a slight decrease in the incidence of colon cancer was observed in Poland, which is largely due to the centrally organized screening program based on colonoscopy and invitations - said Dr. Pilonis.
- In 2021, the financing of the program was transferred to the National Health Fund, and screening colonoscopy was introduced to the benefits package. The program was decentralized and fragmented. Central quality coordination and verification of indications were removed, and it is not really clear what to do after the screening test - the specialist listed.
- Now we need to say it clearly: we currently do not have a colon cancer prevention program in Poland, because without coordination it does not meet international guidelines. For the population aged 50-65, we simply offer screening colonoscopy financed by the National Health Fund - she clarified.
Dr Pilonis also referred to the Moje Zdrowie programme, under which a FIT test for occult blood in stool can be performed at primary healthcare facilities. She recalled that, in terms of international guidelines, the test is equivalent to colonoscopy in terms of the possibility of early detection of cancer and reducing mortality due to it, so it is a good option.
- At the same time, it is worrying, if we consider that it operates independently of the centrally managed program. We recently verified whether laboratories testing haemoglobin concentration in stool have a cut-off point for a positive level. It turned out that this level is different in different laboratories. This means that the same person may have a positive or negative test result, depending on where it is performed - explained the specialist.
As she said, such arbitrariness can have disastrous consequences for a specific person , because the test result determines whether a person will be referred for more in-depth diagnostics for colon cancer. In this way, the chance to detect cancer at an early stage can be wasted.
- This shows how important the need for coordination and introduction of clear standards for laboratories is. It is also an example of the fact that scattered preventive actions have no chance of positively influencing epidemiological trends at the population level. This investment will therefore be wasted - assessed Dr. Pilonis.
- This is a big problem, which we have been reporting for some time through the National Oncology Council. It should also be recalled that in the National Oncology Network, supervision over prevention is assigned to the Provincial Monitoring Centers. This task is impossible in the current system - added Prof. Rutkowski.
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