Primary prevention of colorectal neoplasias: ample evidence, lack of guidelines.

Abstract

Colorectal cancer (CRC) is the third most commonly diagnosed type of malignancy in males and the second in females, with over 1.2 million new cancer cases and 608,700 deaths estimated to have occurred in 2008 [1]. Sporadic CRC accounts for 75% of the total CRC cases, with colorectal adenoma regarded as the precursor lesion (adenoma-carcinoma sequence) [2]. Despite the major advances in the screening methods, treatment options and follow-up frameworks, there is ample evidence highlighting the preventability of colorectal neoplasias by the implementation of appropriate lifestyle modifications, with the most extensively studied parameters being the effects of physical activity, specific dietary patterns, smoking and alcohol consumption [3]. Moreover, the chemoprevention of colorectal neoplasias is an area of ongoing research, focusing on the potentially preventive role of certain drugs and micronutrients [4]. Although there is now solid evidence regarding the clear protective role of lifestyle modification in terms of preventing colorectal neoplasias, there is lack of specific guidelines from the leading health organizations and professional bodies, with the currently available guidelines providing general rather specific frameworks for establishing national preventive policies. Herein, we attempt to pinpoint in a best evidence topic frame the key findings in the field of primary prevention of colorectal neoplasias, underlining the necessity of a qualitive turn towards setting specific lifestyle modification targets instead of general guidance.