Investigators may have identified colorectal cancer screening programs in Latin America, according to a recent systematic review and meta-analysis published by Montalvan-Sanchez et al in JAMA Network Open.
Background
Colorectal cancer—the second leading cause of cancer-related mortality globally—may not have symptoms in its early stages. Screening for colorectal cancer may enable earlier diagnosis with better prognosis or cancer prevention through the surgical resection of precancerous polyps. Although colorectal cancer disproportionately affects high-income countries, the incidence and mortality of the disease are increasing in low and high middle-income countries, including most Latin American countries.
With the exception of the United States and Canada, little is known about the colorectal cancer screening strategies used throughout the Western Hemisphere. A complete picture of colorectal cancer in Latin America is not available as a result of uncertain completeness of data collection from its cancer registries; however, limited resources and infrastructure as well as the absence of public awareness in much of the region may be partially responsible for rising cases.
“Most of the patients who I see here in Indianapolis are immigrants from Latin America who speak little English. When I try to discuss colorectal cancer screening with them, it’s something new, something they have not been exposed to, unlike, for example, the availability of COVID-19 vaccines,” stressed lead study author Eleazar Montalvan-Sanchez, MD, an internal medicine resident physician at the Indiana University School of Medicine. “I recall a recent patient who immediately refused a colonoscopy but didn’t give me any reason. When, at his next appointment, we discussed his refusal, he shared that he had said no because he had never heard about [colorectal cancer screening] before," he continued.
Study Methods and Results
In the recent systematic review and meta-analysis, the investigators analyzed previous cancer screening studies involving 124,000 patients in Latin America that were published in English, Spanish, and Portuguese. They discovered a lack of screening programs in low middle-income countries such as Honduras, El Salvador, Guatemala, and Bolivia. They also found that the prevalence of colorectal cancer in high middle-income countries such as Brazil, Argentina, Uruguay, and Chile was similar to the prevalence in high-income countries.
Additionally, the investigators revealed that colorectal cancer screening strategies employing noninvasive fecal immunochemical tests (FIT), screening colonoscopies, or both had been successfully implemented in Brazil, Argentina, Mexico, Costa Rica, Uruguay, and Chile—all of which were high middle-income Latin American countries. These countries had high uptake (86%) of screening. Notably, more than 75% of the patients received a colonoscopy following positive results from stool testing in this subset.
Conclusions
The findings highlighted the need for more robust colorectal cancer screening and cancer prevention research initiatives throughout Latin America. The investigators suggested that establishing population-level structured screening programs in Latin America, at least in high middle-income countries, would potentially be as effective at reducing the colorectal cancer–related disease burden as they are in other countries.
“I would expect that more organized cancer screening would have the same benefit for these countries as it has for the [United States], Canada, and European countries,” indicated senior study author Thomas Imperiale, MD, the Lawrence Lumeng Professor of Gastroenterology and Hepatology at the Indiana University School of Medicine and a research scientist at the Regenstrief Institute. “FIT would be a good screening choice economically and logistically throughout Latin America. If countries are interested in cost effectiveness, efficiency, and reach, FIT would appear to be the test of choice. Worldwide, it’s the most commonly used screening test,” he added.
Further, the research may be integral for patients, physicians, and policymakers in the United States as well as in Latin America. “It’s important for physicians in the [United States] to know about colorectal cancer screening in Latin America as we work to improve health outcomes for this population,” underlined Dr. Montalvan-Sanchez.
“This systematic review and meta-analysis found both the substantial burden of colorectal neoplasia and the feasibility of organized screening programs in Latin America. It also highlights the need for more data on [the colorectal cancer] burden or screening feasibility in the Latin American [low middle-income countries]. [Colorectal cancer] incidence is rising in Latin America as fast as anywhere in the world, warranting effective preventive measures, particularly with cost-effective, FIT-based screening programs. [Colorectal cancer] screening should become a greater research and public health priority in Latin America,” the study authors concluded.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
