At the recently held scientific-practical conference “Challenges of colon cancer: endoscopy or surgery – where is the line?” Professor Tomas Poškus, surgeon at Santaras Clinics of Vilnius University Hospital, said that the main weapon to reduce mortality and morbidity is the screening program.
Colon cancer is one of the most common and dangerous oncological diseases in Lithuania. More than 1,500 new cases are registered every year, and this disease takes about 1,000 lives.
One of the main risk factors for this disease is age. Even without feeling any ailments, people aged 50-74 should have a prophylactic test for occult bleeding once every two years. If the answer is yes, the next step is a colonoscopy.
“About 8 percent cases, the occult blood test is positive, which means that traces of blood are detected in the stool. Such patients should be examined with an endoscope and a colonoscopy performed”, said T. Poškus.
During a colonoscopy, the large intestine is examined with a flexible device – an endoscope. If necessary, pieces of tissue are taken for examination (biopsy), various formations that can be malignant are removed, which means that there will be no serious disease.
Professor T. Poškus regretted that recently only a few young doctors are being trained for gastroenterology residency studies, which means that in the future there may be a shortage of specialists who would remove changes in the mucous membrane and protect against cancer without surgery, but only with an endoscope.
– In Lithuania, there is a great opportunity for free check-ups for healthy people who do not yet feel anything bad. What does the program data show? – I asked Professor T. Poškaus.
– More than one thousand precancerous lesions – adenomas – are diagnosed every year. If the adenoma is removed, it means that the person will not get colon cancer. The goal of the program is to reduce not only mortality from colon cancer, but also morbidity.
– Do we have something to emulate?
– The indicators of our country correspond to the average of the European Union. In Lithuania, the colon cancer screening program started early, for example, in our country it started in 2008, and in the Netherlands – only in 2016.
Although in the Netherlands this program started 8 years later than in Lithuania, it was well prepared. In order for the program to function flawlessly as in the Netherlands, in Lithuania all persons in the target group should receive a sample and undergo a occult bleeding test, and those who have a positive test result should receive a colonoscopy within a month. In order to realize such goals, additional resources are necessary.
– In which chain is Lithuania lagging behind the most?
– If the program in Lithuania were to run like in the Netherlands, we would need to perform four times more colonoscopies. Who can say how to train so many doctor endoscopists in a short time?
The number of patients waiting for a colonoscopy is increasing across the country, not just in big cities, and this is a major drag on the program.
I will give you the following example: in Lithuania, one endoscopist doctor can perform ten high-quality conoscopies per day. If we have 200 working days, and the endoscopist does nothing but colonoscopies, then such a specialist will perform 2000 colonoscopies in a year.
If we want to catch up with the Netherlands, 50,000-60,000 colonoscopies should be performed in Lithuania every year. We don’t have that many specialists, and the ones we have can’t drop everything and do only colonoscopies, after all, the doctor consults not only about the colon, but also about other diseases.
It is clear that the greatest shortage is of medics. We can buy additional medical equipment, reagents, but we cannot buy specialists.
Residency studies in gastroenterology last 5 years, currently only one such specialist is being trained in Vilnius, three in Kaunas. This is a concern because it is not clear where we will get new specialists from in the future.
– How do other countries find a way out?
– Doctors in the Netherlands have calculated in advance what resources will be needed to implement a colon cancer screening program. They decided to apply this program only eight years later, because it was necessary to additionally train specialists, purchase equipment, and establish new offices.
This is the path of rich countries. We are also a rich country, as assessed by international experts. In terms of quality of life, Lithuania is in the top ten or fifteen percent of the best countries, I could never have thought that Lithuania would develop so rapidly, and we are still lagging behind in the fight against colon cancer, although this disease is preventable.