Sociodemographic factors and strategies in colorectal cancer screening: a narrative review and practical recommendations.

Background: Worldwide colorectal cancer is a frequently occurring cancer with a high disease burden. It is the second most frequent cancer in women and the third in men. The incidence of colorectal cancer is increasing because of ageing and unhealthy lifestyles.Aim: We aimed to perform a narrative literature review on methods and strategies for screening for colorectal cancer prior to colonoscopy.Design: Narrative literature review.Methods: The databases PubMed, Web of Science, Embase and The Cochrane Library were searched using keywords: 'colorectal cancer', '(mass) screening', 'occult blood', 'prevention', 'socioeconomic status', 'early diagnosis', 'Europe' and 'ethnicity'/'ethnic groups'.Results: 18 articles were included. Multiple randomised controlled trials have shown that screening programmes with faecal occult blood tests (FOBT), guaiac-FOBT (gFOBT) and immunochemical FOBT (iFOBT) represent a valid prevention strategy. Most studies favour iFOBT, because of ease to use, resulting in a higher uptake of screening, as well as a higher detection rate. A higher uptake is also achieved by mailing of the test. Overall the uptake of screening is higher in women, although more cancers are diagnosed in men. This can be explained by a lower sensitivity of FOBT in women. Furthermore, a strong correlation was found between a low socio-economic status and a low uptake of screening. The screening age lies between 50-74 years.Conclusion: Colorectal cancer is characterized by a significant incidence, morbidity and mortality. Systematic screening is effective for early detection. A non-selective test with iFOBT currently has the best validity with a higher sensitivity in men.

Toxic hepatitis due to a food supplement: "Natural" is no synonym for "harmless".

BACKGROUND/AIMS: Herbal products are increasingly used in modern medicine for numerous indications. They are not considered as drugs and thus often not linked to side effects. MATERIAL: A 77-year-old patient presented with silent icterus and biochemical evidence of hepatocellular damage. Because of dyslipidaemia, he was recently prescribed Controchol(®), a food supplement containing red yeast and green tea extracts. RESULTS: Liver biopsy showed necro-inflammatory destruction of liver parenchym, collapse of reticulin matrix, cholestasis and gall duct damage, compatible with toxic hepatitis. After discontinuation of Controchol(®), there was a gradual normalisation of the liver function tests. Liver injury is a known side effect of both red yeast and green tea extracts. After exclusion of other causes, we therefore concluded our patient had suffered from Controchol(®)-induced toxic hepatitis. CONCLUSION: Products that are conceived as "natural" alternatives for pharmacological drugs, like food supplements, are not free of side effects per se, and should not be considered as "harmless".