Over 148,000 colonoscopies missed in two years of pandemic

Screening for colorectal cancer by colonoscopy was affected during the first two years of Covid-19, underlines the Brazilian Society of Surgical Oncology (SBCO). Compared to 2019, there was a reduction of 30.4% in 2020 and 12.4% in 2021 in the number of examinations at SUS. Colonoscopy has the potential to prevent disease because it removes polyps that can progress to cancer of the large intestine and rectum.

Colorectal cancer (large intestine/colon and rectum) is the second most common malignancy, excluding non-melanoma skin cancer, in men and women in Brazil, behind prostate cancer respectively and breast. There are 41,000 new cases projected for 2022, according to National Cancer Institute estimates. In reference to Marinho Azul Marinho Disease Awareness Month, the Brazilian Society of Surgical Oncology (SBCO) warns of an even more disturbing fact than this already high incidence of colorectal tumors. At least 148,000 colonoscopies have not been performed in the Unified Health System in the past two years.

This number was noted by SBCO during the verification of the DATASUS database. The system records the performance of 347,098 colonoscopies in 2019. In 2020, when there were more restrictive measures to contain the spread of SarsCov-2, which included the closure of colonoscopy services, 241,329 examinations were performed (a reduction of 30.4% compared to last year) . In 2021, there was an upturn in demand for the exam, however, there was still a significant reduction (304,004 colonoscopies, a 12.4% lower volume than in 2019).

Surgical oncologist and president of SBCO, Héber Salvador, explains that colorectal cancer can develop silently for a period of time, without showing any symptoms. Because of this, the dizzying reduction in colonoscopies in the pandemic is worrying. “When the patient has symptoms, it may already be a sign of a more advanced disease. It is essential to perform a colonoscopy from the age of 50 in people without symptoms – or 40, if there is a history of cancer in the family. This examination can prevent the disease because, thanks to it, it is possible to remove polyps, which are lesions stuck in the intestinal wall that could develop into cancer, “he explains .

Bruno Roberto Braga Azevedo, surgical oncologist and member of the board of directors of SBCO and director of Hospital Pilar and Grupo Oncoclínica, explains that the role of colonoscopy is to prevent the patient from developing the disease and requiring intervention surgical. “Our role, although surgeons, is to prevent the patient from needing this intervention. The decision will depend on the extent, size, and location of the tumor, as well as the patient’s general health. Depending on the case, treatment may include radiotherapy with or without chemotherapy, in order to reduce the possibility of tumor recurrence. In the event of metastasis, the chances of recovery are reduced, but there are effective therapies, combining chemotherapy and surgical rescue. Therefore, in specific cases, metastatic patients can achieve long periods of survival and even recovery, depending on the condition and the response to treatment.

What are the warning signs? – Changes in bowel habits (alternation of diarrhea and constipation), as well as changes in stool shape (very thin and long stools), are warning signs that should be looked for. Other common symptoms are blood in the stool, abdominal pain or discomfort, weakness and anemia, and weight loss for no apparent reason.

How to prevent? – It is recommended to adopt a diet that includes the consumption of fruits and vegetables, as well as avoiding the consumption of processed foods and alcoholic beverages, soft drinks and other sugary drinks. Moderation is also the key word with regard to red meat and high calorie and/or fatty foods. Other risk factors are physical inactivity, obesity and smoking.

Heredity accounts for between 5% and 10% of cases, with Lynch syndrome being the most common. There is also familial adenomatous polyposis, which occurs when patients have more polyps and need to have colonoscopy more frequently.

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