We asked our SCPN team and friends what they thought was the most interesting paper that had come across their desks this year. Professor Callum G Fraser, Senior Research Fellow, University of Dundee and Founding Member of the Expert Working Group on FIT for Screening, CRCSC, World Endoscopy Organization has chosen his paper of 2019 which discusses the important topic of the increasing incidence for colorectal cancer in young adults.

Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years.

Fanny ER Vuik, Stella AV Nieuwenburg, Marc Bardou et al.

GUT Journal

http://dx.doi.org/10.1136/gutjnl-2018-317592

Why this paper?

The media is replete with horror stories about young people who were discovered to have advanced colorectal cancer (CRC), often after many visits to health care professionals. This impressive study assessed 143.7 million people,aged 20-49 years,from 20 European countries. Only 187 918 (0.13%) had CRC. On average, CRC incidence increased 7.9%, 4.9% and 1.9% per year in those aged 20-29, 30-39 and 40-49 years.Thus, the argument to solve the problem simply by lowering the age to start screening to 45 years seems rather less than cogent. Further research on possible causes including lack of exercise, diet, smoking, alcohol and obesity is known to be in progress. In addition, the microbiome, influenced by diet and environment, might be important.

In the meantime, perhaps countries could well follow Scotland’s lead and make faecal immunochemical tests (FIT) ubiquitously available in primary care to all patients presenting with any lower bowel symptoms.