In cancer Primary Prevention,including colorectal cancer (1), doctors around the world need a clinical tool that helps them in bed side recognizing,starting from the birth, on very large scale and in apparently healthy individuals, genetical errors, e.g., hyperinsulinemia-insulinresistance, melatonine and SST deficiency, metabolic disorders, prevalence of stress axis, a.s.o., which either bring about or aggravate n-DNA as well as mit-DNA alterations, as those observed in cancer cells(1-8). In fact, our target, i.e., colorectal cancer primary prevention surely better than cancer screening, can be reached hopefully if doctors are able to ascertain or at least suspect at the bed-side in apparently healthy subjects chromosomal aberrations before malignancy on-set (1-12). In other words, physicians must recognize and quantify clinically both Oncological Terrain and inherited colorectal cancer Real Risk, based on newborne-pathological, type I, subtype a), oncological, colon endoarteriolar Blocking Devices (See www.semeioticabiofisica.it/microangiology, Physiology and Pathology) (2-8). As a working hypothesis, I thought previously that all chromosomal alterations, of whatever nature, are necessarily accompanied with similar microvascular modification of the local microcirculatory bed, both structural and functional in nature, in subject involved by abnormalities of pschyco-neuro-endocrinological-immune system (6). As a matter of fact, both genetical and environmental factors induce contemporaneously parenchymal and microvascular cells alterations, according to the well-known concept of Tiscedorf's Angiobiotopie, I completed with that of Angiobiopathy (6). As a consequence, in all researches on colorectal cancer primary prevention, we must enrolle exclusively individuals positive for Oncological Terrain AND inherited colorectal cancer Real Risk, conditio sine qua non of oncogenesis. Now, fortunately, thanks to Biophysical Semeiotics (ibidem), we can evaluate clinically microcirculatory bed structure and function in a precise manner and therefore microcirculatory remodelling, oncological inherited Real Risk is based on (6-12).
My 51-year-long "clinical" experience allows me to state that the decline in cancer rates all over the world could be more intense when scientists will think over and discuss the possibility that exists the Oncological Terrain and Inherited Oncological Real Risk, conditio sine qua non of oncogenesis (9-12). As a matter of fact, e.g., not all smokers are involved by pulmonary cancer, as well as not all people with chronic hepatitis will die of hepatocarcinoma. On the other side, in some families malignancies occur more frequently than in others. Actually, as I described in the above-mentioned papers, there are other causes that accounts for the reason of existence of the oncological "real" risk, i.e. oncological terrain.
From the above remarks, the following critical comment is really useful:
Guidance Statement 1 ACP recommends that clinicians perform individualized assessment of risk for colorectal cancer in all adults..... involved by Oncological Terrain-Dependent Inherited Real Risk of colorectal cancer!
Guidance Statement 2 ACP recommends that clinicians screen for colorectal cancer in average-risk adults starting at the age of 50 years and in high-risk adults starting at the age of 40 years or 10 years younger. Not at all. We are able to bedside evaluate Oncological Terrain-Dependent Inherited Real Risk of colorectal cancer, and its evolution, possible also in younger!
Guidance Statement 3: ACP recommends using a stool-based test, flexible sigmoidoscopy, or optical colonoscopy as a screening test in patients who are at average risk. Not at all. We must use these diagnostic tools when and if necessary, according to above cited data of physical examination!
Guidance Statement 4: ACP recommends that clinicians stop screening for colorectal cancer in adults over the age of 75 years or in adults with a life expectancy of less than 10 years. Not at all. If I, 80 year-old, woul be involved by Oncological Terrain-Dependent Inherited Real Risk of colorectal cancer or cancer I would need the most up-dated therapy!
References.
1)Sergio Stagnaro. Stagnaro's *Sign in detecting every gastrointestinal Disorder, even initial or symptomless. Journal of Quantum Biophysical Semeiotics. 28 July, 2011. http://www.sisbq.org/uploads/5/6/8/7/5687930/stagnarosign.pdf
2) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica del torace, della circolazione ematica e dell'anticorpopoiesi acuta e cronica. Acta Med. Medit. 13, 25 1997
3) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: la manovra di Ferrero-Marigo nella diagnosi clinica della iperinsulinemia-insulino resistenza. Acta Med. Medit. 13, 125 1997
4) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: valutazione clinica del picco precoce della secrezione insulinica di base e dopo stimolazione tiroidea, surrenalica, con glucagone endogeno e dopo attivazione del sistema renina-angiotesina circolante e tessutale - Acta Med. Medit. 13, 99.
5) Stagnaro S., Sindrome percusso-ascoltatoria di Iperfunzione del Sistema Reticolo-Istiocitario. Min. Med. 74, 479, 1983 (Medline)
6) Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeiotica Biofisica. Il Terreno Oncologico. Travel Factory, Roma, 2004. www.travelfactory.it
7) Stagnaro Sergio. Reale Rischio Semeiotico Biofisico. I Dispositivi Endoarteriolari di Blocco neoformati, patologici, tipo I, sottotipo a) oncologico, e b) aspecifico. Ediz. Travel Factory, www.travelfactory.it, Roma, 2009.
8) Stagnaro S. Rimodellamento Microvascolare, Costituzioni Semeiotico-Biofisiche e Reale Rischio Semeiotico-Biofisico. Ruolo dei Dispositivi Endoarteriolari di Blocco neoformati-patologici www.clicmedicina.it, 10/4/2007, http://www.clicmedicina.it/pagine%20n%2028/rimodellamento.htm
9) Sergio Stagnaro and Simone Caramel (2011). The genetic Reversibility in Oncology, Journal of Quantum Biophysical Semeiotics, http://www.sisbq.org/uploads/5/6/8/7/5687930/reverse_oncology.pdf
10) Stagnaro S., Stagnaro-Neri M., Oncological Terrain, conditio sine qua non of Oncogenesis, 2004: http://www.gutjnl.com/cgi/eletters?lookup=by_date&days=60
11) Stagnaro S. Cancer Risk Factors and Oncological Terrain. 2006. http://www.wjso.com/content/4/1/74/comments#247528
12) Sergio Stagnaro and Simone Caramel (2012) New ways in physical Diagnostics: Brain Sensor Bedside Evaluation. The Gandolfo's Sign. January, 2012. Journal of Quantum Biophysical Semeiotics. http://www.sisbq.org/uploads/5/6/8/7/5687930/bsbe.pdf
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