KOCHI: With incidence of colorectal cancer rising in India, gastroenterologists are now advising early screening . The ideal age that one needs to go for screening of colorectal cancer (CRC) was discussed in detail at a conference of gastroenterologists, with majority agreeing that patients should be advised to go for screening without waiting for symptoms to appear.At present, the doctors advise colonoscopy for alarm symptoms. However, now gastroenterologists are asking for screening on people before symptoms appear, especially since they appear late in CRC, which is a preventable disease. Screening can be through colonoscopy, sigmoidoscopy or faecal occult blood (FOB) testing.This is mainly because majority of those detected with CRC have no family history and the common onset of disease is 40 years.The average age of diagnosis of CRC in India is 47.5 years. In Kochi, the prevalence of young CRC is around 24%. A study at six private hospitals in the state that was presented at the conference showed that about 17% detected with CRC are below the age of 50. "The question now is what is the right age to screen? Is it 35, 40 or 45? This is crucial since the most significant increase in CRC has occurred in patients of ages 40 to 44 and the number of CRC patients over 50 is declining. Consideration should be given for age-based colonoscopic screening at the age of 40," said gastroenterologist Dr Rajeev Jayadevan and author of the study at six private hospitals.WHO data shows that the estimated mortality incidence of colorectum cancer in Indian men is 5.4 in 1 lakh population and women is 7.2 in 1 lakh. However, doctors said that this may not be the exact data as there is no proper screening with many CRCs silent and death registers unreliable."Nearly 80% to 95% of colorectal cancer (CRC) is sporadic, that is no family history. Being vegetarian doesn't protect against CRC. Studies have shown that those who ate red meat and vegetarians were equally at risk of CRC," said Dr Jayadevan.World health organisation (WHO) criteria for cancer screening states that the target disease should be serious and common, effective treatment should be available and test procedures should be acceptable, safe and relatively inexpensive.So how effective are early screening strategies? "It helps prevent cancer and thereby prevent deaths. But screening is not done much in India. And the situation is no different in Kerala, where patient feels that why should they test if there are no symptoms. People need to know that if detected early it can be prevented or cured," said Dr Benoy Sebastian, former secretary, Indian Society of Gastroenterology, Kerala chapter. Studies in the West have shown that early detection has led to 53% reduction in deaths.The cost of colonoscopy is around Rs 2,600 to Rs 12,000 in private sector and Rs 350 to Rs 850 in government sector.

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