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com/1948-5204office World J Gastrointest Oncol 2012 April 15; 4(4): 82-83

TOPIC HIGHLIGHT

Mohamad Amin Pourhoseingholi, PhD, Series Editor

Colorectal cancer screening: Time for action in Iran

Mohamad Amin Pourhoseingholi, Mohammad Reza Zali

Mohamad Amin Pourhoseingholi, Mohammad Reza Zali, Pourhoseingholi MA, Zali MR. Colorectal cancer screening: Time
Research Center of Gastroenterology and Liver diseases, Shahid
for action in Iran. World J Gastrointest Oncol 2012; 4(4): 82-83
Beheshti University of Medical Sciences, Tehran 1985711151,
Available from: URL: http://www.wjgnet.com/1948-5204/full/
Iran
Author contributions: The two authors contributed equally in v4/i4/82.htm DOI: http://dx.doi.org/10.4251/wjgo.v4.i4.82
manuscript writing.
Correspondence to: Mohammad Reza Zali, Professor, Re-
search Center of Gastroenterology and Liver diseases, Shahid
Beheshti University of Medical Sciences, Tehran 1985711151, Cancer is the third most common cause of death in Iran[1].
Iran. aminphg@gmail.com
Gastrointestinal cancers are the most frequent cancer
Telephone: +98-21-22432515 Fax: +98-21-22432517
Received: May 18, 2011 Revised: March 3, 2012
among Iranian males and second to breast cancer among
Accepted: March 10, 2012 females[2].
Published online: April 15, 2012 Colorectal cancer (CRC) is a public health burden in
most industrialized countries[3] and is now the third most
common cause of cancer-related deaths in the world[4].
According to the Iranian annual national Cancer Registra-
Abstract tion Report, CRC is the third most common cancer in Ira-
nain women and fifth in men. The incidence of CRC has
Colorectal cancer (CRC) is now the third most common
increased during the last 25 years[5]. Iranian data suggest a
cause of cancer-related deaths in the world. According
younger age distribution for CRC compared to Western
to the Iranian Annual National Cancer Registration Re-
port, CRC is the third most common cancer in Iranian
reports[5-7].
women and fifth in men. The incidence of CRC has CRC screening is an efficient way to reduce the bur-
increased during the last 25 years. CRC screening is den of CRC through detection of precursor lesions of
an efficient way to reduce the burden of CRC through cancer or early stage cancer. The 5-year survival rate of
detection of precursor lesions of cancer or early stage CRC diagnosed early was reported to be around 90%[8,9].
cancer. Iran may benefit even more from screening The overall mortality rate of CRC was reduced by 16%,
programs. According to recent studies, the prevalence 12 to 18 years after the beginning of cancer screening[10],
of colorectal adenoma in first degree relatives of pa- and the mortality rate of persons aged 50 to 75 years was
tients diagnosed with CRC is significantly higher than in also found to be reduced[11].
the average risk population. So, appropriate screening Screening guidelines recommend that average risk in-
strategies, especially in relatives of patients, should be dividuals initiate CRC screening at age 50 years[12,13], while
considered as the first step of CRC screening in Iran. high-risk individuals should obtain screening earlier[8,12].
Most cases of CRC (around 80%) are probably caused
© 2012 Baishideng. All rights reserved. by environmental factors although in up to 5% of all CRCs,
genetic factors play a dominant role[14,15]. The most com-
Key words: Colorectal cancer; Screening; Prevention; mon hereditary syndromes are Lynch syndrome (heredi-
Relatives; Iran tary nonpolyposis CRC), familial adenomatous polyposis
and MUTYH-associated polyposis[16]. So, individuals with
Peer reviewer: Xiao-Chun Xu, Associate Professor, Department
of Clinical Cancer Prevention, The University of Texas M. D. a personal or family history of CRC[12], history of pol-
Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1360, yps[8,12], Crohn’s disease or ulcerative colitis[17] are at high
Houston, TX 77030, United States risk.

WJGO|www.wjgnet.com 82 April 15, 2012|Volume 4|Issue 4|

Iran, because of its demographic characteristics, may colonoscopy in screening for colorectal cancer. Ann Intern
benefit even more from screening programs. The distri- Med 2000; 133: 573-584
4 Parkin DM. Global cancer statistics in the year 2000. Lancet
bution of CRC has shifted towards lower age groups and, Oncol 2001; 2: 533-543
half of Iranian CRC patients are currently aged less than 5 Azadeh S, Moghimi-Dehkordi B, Fatem SR, Pourhoseingholi
50 years of age[7]. MA, Ghiasi S, Zali MR. Colorectal cancer in Iran: an epide-
Although the facts mentioned above, suggest that miological study. Asian Pac J Cancer Prev 2008; 9: 123-126
implementation of screening and surveillance programs 6 Pourhoseingholi MA, Vahedi M, Moghimi-Dehkordi B,
Pourhoseingholi A, Ghafarnejad F, Maserat E, Safaee A,
should be highly beneficial, the necessity of conducting Mansoori BK, Zali MR. Burden of hospitalization for gastro-
such programs and the exact methods for performing intestinal tract cancer patients - Results from a cross-section-
them should be more thoroughly investigated. al study in Tehran. Asian Pac J Cancer Prev 2009; 10: 107-110
Initially, the epidemiology of CRC and adenomatous 7 Moghimi-Dehkordi B, Safaee A, Zali MR. Prognostic factors
polyps can be determined according to data banks, regis- in 1,138 Iranian colorectal cancer patients. Int J Colorectal Dis
2008; 23: 683-688
try systems and research studies. Then, measures should 8 Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks
be taken to determine the high risk groups for CRC D, Bond J, Dash C, Giardiello FM, Glick S, Johnson D, John-
in order to promote early diagnosis. However, actions son CD, Levin TR, Pickhardt PJ, Rex DK, Smith RA, Thorson
should not be confined to determining vulnerable groups A, Winawer SJ. Screening and surveillance for the early de-
and all groups of people who might benefit from screen- tection of colorectal cancer and adenomatous polyps, 2008:
a joint guideline from the American Cancer Society, the
ing should be included in programs and the cost-benefit US Multi-Society Task Force on Colorectal Cancer, and the
estimated[18]. American College of Radiology. Gastroenterology 2008; 134:
In an unmatched case control study conducted in 1570-1595
our research center, a significant positive correlation 9 Smith RA, von Eschenbach AC, Wender R, Levin B, Byers
was found between the number of affected relatives per T, Rothenberger D, Brooks D, Creasman W, Cohen C, Runo-
wicz C, Saslow D, Cokkinides V, Eyre H. American Cancer
family and the risk of CRC, which increased nearly three- Society guidelines for the early detection of cancer: update
fold[19]. Another study based on colonoscopy screening of early detection guidelines for prostate, colorectal, and en-
showed that the prevalence of colorectal adenoma and dometrial cancers. Also: update 2001--testing for early lung
precancerous lesions in first degree relatives of patients cancer detection. CA Cancer J Clin 2001; 51: 38-75; quiz 77-80
diagnosed with CRC is significantly higher than in the av- 10 Whitlock EP, Lin JS, Liles E, Beil TL, Fu R. Screening for
colorectal cancer: a targeted, updated systematic review
erage risk population[20]. for the U.S. Preventive Services Task Force. Ann Intern Med
It remains to be determined which method of screen- 2008; 149: 638-658
ing yields a better outcome. Randomized and non- 11 U.S. Preventive Services Task Force. Screening for colorec-
randomized studies are needed to assess the efficacy of tal cancer: U.S. Preventive Services Task Force recommenda-
tion statement. Ann Intern Med 2008; 149: 627-637
screening programs. However, reaching a consensus in
12 American Cancer Society. Cancer facts and figures 2009. At-
this regard may take a long time. So, in the meantime, lanta: American Cancer Society, 2009
implementation of CRC screening programs will be a 13 Smith RA, Cokkinides V, Eyre HJ. Cancer screening in the
matter of moral decision-making instead of being based United States, 2007: a review of current guidelines, practices,
on current data. and prospects. CA Cancer J Clin 2007; 57: 90-104
14 Slattery ML, Levin TR, Ma K, Goldgar D, Holubkov R, Ed-
The prevalence of disease, its hygienic burden, ap-
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sis colon cancer. Gastroenterology 2001; 121: 830-838
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program should be conducted. characteristics. Lancet Oncol 2000; 1: 220-226
In conclusion, appropriate screening strategies espe- 17 Bernstein CN, Blanchard JF, Kliewer E, Wajda A. Cancer
cially in relatives of patients should be considered as the risk in patients with inflammatory bowel disease: a popula-
first step in CRC screening in Iran. tion-based study. Cancer 2001; 91: 854-862
18 Zali MR. Colorectal cancer - screening in Iran. Gastroenterol
Hepatol Bed Bench 2008; 1: 103-104
19 Safaee A, Moghimi-Dehkordi B, Pourhoseingholi MA, Va-
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S- Editor Wang JL L- Editor Hughes D E- Editor Zheng XM

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