Colorectal cancer is the third most common cancer worldwide and the second leading cause of cancer-related deaths. It usually develops slowly over 5-10 years, so early detection can significantly improve treatment outcomes and reduce mortality rates. National screening programs in China, Australia, and the U.S. demonstrate the positive impact of early screening. In July 2024, Australia lowered the screening age from 50 to 45, emphasizing early detection as cancer rates rise among those under 50. Advances in non-invasive tests, such as #BGI's DNA methylation testing, offer easier and effective options. It is by taking action now and by using the latest tests to identify colorectal cancer at an early stage that can have the greatest impact on people’s lives, today.
China, 9th Aug 2024 - In July 2024 Australia lowered the entry age for its National Bowel Cancer Screening Program from 50 to 45 and became the latest country to recognize that the early detection of colorectal cancer can have a significant impact on people’s lives, especially with cancer rates rising among Australians under 50. From 1982-2014 the incidence of bowel cancer increased 9% for those under 50.
Colorectal cancer is the third most common cancer worldwide and the second leading cause of cancer-related deaths. However, colorectal cancer usually develops slowly over a period of 5-10 years which means that early detection can make a very real difference in terms of treatment and mortality rates.
Yet, despite many countries implementing national screening programs, by 2040 the burden of colorectal cancer is projected to increase to 3.2 million new cases and 1.6 million deaths per year representing a 66% and 71% rise in new cases and deaths, respectively, relative to 2020.
More action is needed to persuade people to undergo screening and at an earlier age. However, as BGI identified in its 2024 Global State of Colorectal Cancer Awareness Report, there is a significant gap around the world in awareness of and accessibility to screening programs, with the main barriers to screening being cost and fear.
For many people cancer is a stigma and a highly emotional topic. Most will have known relatives or friends who died from cancer and there is a fear both around being diagnosed with the life-threatening disease and fear of the detection process itself. While colonoscopy is considered the gold standard by doctors for cancer detection, it is invasive and requires both fasting and purging that deters many people from being screened until the disease has developed beyond its early stages, significantly reducing life expectancy rates.
Another widely used test in colorectal screening is fecal immunochemical testing (FIT). This is a stool test that detects hidden blood in the stool which can be a sign of precancerous polyps or colorectal cancer. However, as a screening method FIT has limitations in terms of when the sample can be collected and has a low (11%-29%) detection rate for pre-cancer or early-stage adenomas polyps as well as a high false positive rate.
Advances in detection methods have resulted in a new test that undertakes non-invasive DNA methylation of a stool sample to detect colorectal cancer. Methylation is a biological process in which a small molecule called a methyl group is added to DNA. This can have several impacts including inhibiting the gene, leading to diseases such as a cancers. If the result is positive for biomarkers, a colonoscopy can be performed for more detailed diagnosis. This is easier for people to use and does not have the limitations of FIT testing, nor the expense of a colonoscopy unless one is really needed.
BGI’s COLOTECT test is one of the DNA methylation tests widely available for colorectal cancer. While the screening frequency for FIT is annually, stool DNA tests only need to be performed every three years if the test result is normal. COLOTECT uses multiplex methylation-specific PCR technology to trace abnormal DNA methylation markers in colorectal cancer from stool samples. It has 88% colorectal cancer sensitivity in early detection, which is important since colorectal cancer develops slowly and may not be detected at an early stage when treatment can be more effective.
China has a high rate of bowel cancer with the incidence increasing among those under 50. In 2021-2022 Wuhan implemented a colorectal cancer screening study for people aged 45-60. 98,683 people participated in fecal DNA methylation testing with 4.5% screening positive and leading to colonoscopy diagnosis findings in 2,347 people. This indicates the effectiveness of the fecal DNA methylation test.
In Harbin, an extensive free screening project was launched in March 2024 for 800,000 eligible permanent residents aged 45-64. Powered by the newly established BGI-Heilongjiang Omics Health Axis Intelligent Laboratory (BGI-HL OHA Intelligent Laboratory), the first phase of the screening project uses BGI's fecal DNA methylation testing to assess the risk of colorectal cancer and advanced adenomas.
Apart from colorectal cancer, this project also screening for hypoglycemia, hyperlipidemia, and hypertension. Large scale public health projects such as these in Harbin and Wuhan are good test cases for the rest of the world on what mass testing can achieve.
National screening programs are certainly helping to improve the detection of colorectal cancer. The U.S. began to promote non-invasive cancer screening much earlier than other countries, and with the introduction of new screening technologies and the continuous improvement of screening coverage, the incidence and mortality rate of colorectal cancer in the U.S. has steadily declined.
Australia’s National Bowel Cancer Screening Program was implemented in 2006, based initially on FIT testing and this has led to the screening age range expanding over time to 50-70 years old and now to 45-74 years old. This has resulted in a drop in mortality from bowel cancer from 44.1/100,000 people in 2006 to 29.8/100,000 people in 2018, and a further decline to 23/100,000 people is expected in 2024.
The expansion of the screening age to 45 years by many countries will undoubtedly bring widespread positive health benefits and help improve overall cancer management and preventative strategies. At the same time, the advances in detection testing also make it more readily acceptable for people to be willing to be tested and earlier detection leads to earlier treatment and a greater likelihood of effective treatments. Together, these advances promise to make colorectal cancer a more manageable condition and much less life-threatening.
The burden on families and societies of cancer can be enormous. Finding a cure is in many ways the holy grail of scientific research. Cancer evolution and development is extensively studied by scientists globally using the latest high-throughput genome sequencing to undertake detailed analysis of DNA coding region mutations leading to colorectal cancer.
In one of the latest studies published recently by Nature, BGI, Uppsala University and other collaborators, undertook the largest integrated genome and transcriptome analysis of colorectal cancer to date, providing ground-breaking insights that could lead to more personalized and effective treatments for colorectal cancer.
While every scientific study leads to an advance in knowledge, it is by taking action now and by using the latest tests to identify colorectal cancer at an early stage that can have the greatest impact on people’s lives, today.
Source:
Lowered eligible age for bowel screening. Australian Government Department of Health and Aged Care. https://www.health.gov.au/our-work/national-bowel-cancer-screening-program/about-the-national-bowel-cancer-screening-program/lowered-eligible-age
Trends in Colon and Rectal Cancer Incidence in Australia from 1982 to 2014: Analysis of Data on Over 375,000 Cases. Cancer Epidemiology, Biomarkers & Prevention. https://aacrjournals.org/cebp/article/28/1/83/71847/Trends-in-Colon-and-Rectal-Cancer-Incidence-in
Colorectal cancer. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/colorectal-cancer
BGI Genomics 2024 Global State of Colorectal Cancer Awareness Report. BGI Genomics. https://www.bgi.com/global/news/bgi-genomics-2024-global-state-of-colorectal-cancer-awareness-report
BGI-HL OHA Laboratory Opens in Harbin, Providing Colorectal Cancer Risk Evaluation for 800,000. BGI Genomics. https://www.bgi.com/global/news/bgi-laboratory-opens-in-harbin-providing-colorectal-cancer-risk-evaluation
Sweden’s Uppsala University and BGI Group Jointly Publish the World’s Largest Multi-Omics Study on Colorectal Cancer. BGI Group. https://en.genomics.cn/en-news-275-6977.html
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