Colorectal Cancer Prevention

Colorectal cancer is the second leading cause of mortality in the United States. In the United States, the cumulative lifetime risk of developing colorectal cancer for both men and women is 6%. Despite advances in the management of this disease, the 5-year survival rate in the United States in only 62%. Because only 38% of patients are diagnosed when the cancers are localized to the bowel wall, it is likely that widespread implementation of screening could significantly improve the outcome. Colorectal cancer screening is cost effective, irrespective of the methods used. In addition to currently available methods (fecal occult blood, flexible sigmoidoscopy, colonoscopy, and double contrast barium enema), computed tomographic colonography (virtual colonoscopy) and stool-based molecular screening are under development.Four classes of chemopreventive compounds have demonstrated efficacy in reducing recurrent colorectal adenomas and/or cancer in randomized, controlled trials. They are selenium, calcium carbonate, hormone replacement therapy, and nonsteroidal anti-inflammatory drugs. The mechanisms of action of nonsteroidal anti-inflammatory drugs include inhibition of the cyclooxygenase system as well as cyclooxygenase-independent effects. Considerable effort is being expended to define chemopreventive activity, optimal dose, administration schedule, and toxicity for the coxibs in adenoma recurrence prevention trials. The threshold for tolerating toxicities is very low in asymptomatic individuals at minimally increased risk for colorectal neoplasia.

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Association between Charlson-Deyo Score and delay to colonoscopy in veterans subsequently diagnosed with colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.288 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 288-288

Author(s):

Thi Khuc ◽

Christian Jackson

Keyword(s):

Colorectal Cancer ◽

United States ◽

Occult Blood ◽

The United States ◽

Fecal Occult Blood ◽

Study Cohort ◽

Fecal Occult ◽

Final Study ◽

Increased Risk ◽

History Of

288 Background: Colorectal cancer (CRC) is the second most common cause of cancer deaths in the United States and expected to cause 51,020 deaths in 2019. Early detection with yearly fecal occult blood test (FOBT) has been proven to decrease CRC mortality. A 30-day delay from positive FOBT to colonoscopy is associated with increased risk of CRC. The Veterans Affairs Health System (VAHS) treats approximately 11% of CRCs in the United States. The effects of an aging population, physician shortage, and increased military personnel entering the VAHS may increase demands on VAHS resources. The primary aim of this study was to determine risk factors that caused delay to colonoscopy. Methods: We retrospectively reviewed records of 600 patients referred for colonoscopy from January 1999 to January 2009, who were subsequently diagnosed with CRC. Patients with a prior CRC diagnosis were excluded. The final study cohort consisted of 530 patients. We analyzed the relationship between 10 variables and delay in time from initial consultation to colonoscopy. Variables consisted of age, sex, race, ethnicity, CRC location, marital status, history of mental health diagnosis, tobacco use, substance abuse, Charlson/Deyo (C/D) score and season of referral for colonoscopy. A delay in time was defined as 30 days or greater. Logistic regression analysis adjusted for age, race, CRC location and C/D score. Results: A total of 87.17% of patients experienced a delay in time from initial consultation to colonoscopy. When analyzed with a predictive variable of delay to colonoscopy, C/D score of ≥ 2 versus 0, was associated with higher odds of delay in time to colonoscopy (OR = 2.18, p = 0.02). African American race and Hispanic ethnicity was associated with a higher odds of delay in time to colonoscopy, but was not statistically significant (OR = 1.47, p = 0.47, OR = 1.37, p = 0.48). Conclusions: Patients with a C/D score ≥ 2 were 218% more likely to have delay in time from initial consult to colonoscopy, resulting in a delayed CRC diagnosis. C/D score may be used to determine which patients should have more frequent reminders to schedule their colonoscopy to prevent delays in care. Randomized and prospective studies will need to be performed.

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Prevention of Colorectal Neoplasia

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0036-1584086 ◽

2016 ◽

Vol 29 (04) ◽

pp. 353-362 ◽

Cited By ~ 2

Author(s):

Scott Dolejs ◽

Benjamin Gayed ◽

Alyssa Fajardo

Keyword(s):

Physical Activity ◽

Colorectal Cancer ◽

Vitamin D ◽

Colorectal Neoplasia ◽

The United States ◽

Lifestyle Changes ◽

Dietary Factors ◽

Chemopreventive Agents ◽

Incidence And Mortality ◽

Inflammatory Drugs

AbstractColorectal cancer (CRC) is one of the leading causes of cancer-related morbidity and mortality worldwide. There are well-established screening protocols involving fecal testing, radiographic, and endoscopic evaluations that have led to decreased incidence and mortality of CRC in the United States. In addition to screening for CRC, there is interest in preventing colorectal neoplasia by targeting the signaling pathways that have been identified in the pathway of dysplasia progressing to carcinoma. This review will detail the efficacy of multiple potential preventative strategies including lifestyle changes (physical activity, alcohol use, smoking cessation, and obesity); dietary factors (dietary patterns, calcium, vitamin D, fiber, folate, and antioxidants and micronutrients); and chemopreventive agents (nonsteroidal anti-inflammatory drugs, statins, metformin, bisphosphonates, and postmenopausal hormonal therapy).

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Trends in the utilization of non-steroidal anti-inflammatory drugs in the United States, 1986–1990

Journal of Clinical Epidemiology ◽

10.1016/0895-4356(92)90127-9 ◽

1992 ◽

Vol 45 (9) ◽

pp. 1041-1044 ◽

Cited By ~ 36

Author(s):

Sherine E. Gabriel ◽

Richard A. Fehring

Keyword(s):

United States ◽

The United States ◽

Inflammatory Drugs ◽

Anti Inflammatory

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Developments in Screening Tests and Strategies for Colorectal Cancer

BioMed Research International ◽

10.1155/2015/326728 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 22

Author(s):

Justin L. Sovich ◽

Zachary Sartor ◽

Subhasis Misra

Keyword(s):

Colorectal Cancer ◽

United States ◽

Cancer Mortality ◽

The United States ◽

Screening Tests ◽

Fecal Occult Blood ◽

Common Cause ◽

Crc Screening ◽

The Third ◽

Incidence And Mortality

Background.Worldwide, colorectal cancer (CRC) is the third most common cancer in men and second most common in women. It is the fourth most common cause of cancer mortality. In the United States, CRC is the third most common cause of cancer and second most common cause of cancer mortality. Incidence and mortality rates have steadily fallen, primarily due to widespread screening.Methods.We conducted keyword searches on PubMed in four categories of CRC screening: stool, endoscopic, radiologic, and serum, as well as news searches in Medscape and Google News.Results.Colonoscopy is the gold standard for CRC screening and the most common method in the United States. Technological improvements continue to be made, including the promising “third-eye retroscope.” Fecal occult blood remains widely used, particularly outside the United States. The first at-home screen, a fecal DNA screen, has also recently been approved. Radiological methods are effective but seldom used due to cost and other factors. Serum tests are largely experimental, although at least one is moving closer to market.Conclusions.Colonoscopy is likely to remain the most popular screening modality for the immediate future, although its shortcomings will continue to spur innovation in a variety of modalities.

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The effect of non-steroidal anti-inflammatory drugs on fecal occult blood screening for colorectal neoplasia

The American Journal of Gastroenterology ◽

10.1016/s0002-9270(01)03228-2 ◽

2001 ◽

Vol 96 (9) ◽

pp. S155-S156

Author(s):

O ELAMIN

Keyword(s):

Colorectal Neoplasia ◽

Occult Blood ◽

Fecal Occult Blood ◽

Fecal Occult ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Blood Screening

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Use of nonsteroidal anti-inflammatory drugs and risk of basal cell carcinoma in the United States radiologic technologists study

International Journal of Cancer ◽

10.1002/ijc.26286 ◽

2011 ◽

Vol 130 (12) ◽

pp. 2939-2948 ◽

Cited By ~ 10

Author(s):

Elizabeth K. Cahoon ◽

Preetha Rajaraman ◽

Bruce H. Alexander ◽

Michele M. Doody ◽

Martha S. Linet ◽

...

Keyword(s):

United States ◽

Basal Cell Carcinoma ◽

Cell Carcinoma ◽

Basal Cell ◽

The United States ◽

Radiologic Technologists ◽

Inflammatory Drugs ◽

Anti Inflammatory

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The Hypermobility Syndrome

PEDIATRICS ◽

10.1542/peds.72.5.701 ◽

1983 ◽

Vol 72 (5) ◽

pp. 701-706 ◽

Cited By ~ 3

Author(s):

Frank Biro ◽

Harry L. Gewanter ◽

John Baum

Keyword(s):

United States ◽

The United States ◽

Juvenile Arthritis ◽

Symptomatic Therapy ◽

Musculoskeletal Complaints ◽

Hypermobility Syndrome ◽

Inflammatory Drugs ◽

Anti Inflammatory

The hypermobility syndrome has been recognized as a definitive diagnostic entity among children referred to a Pediatric Arthritis Clinic with musculoskeletal complaints. The diagnosis of hypermobility was made by the ability of the patients to perform at least three of the following maneuvers: (1) extension of the wrists and metacarpal phalanges so that the fingers are parallel to the dorsum of the forearm; (2) passive apposition of thumbs to the flexor aspect of the forearm; (3) hyperextension of elbows (≥10 degrees); (4) hyperextension of knees (≥10 degrees); (5) flexion of trunk with knees extended so palms rest on the floor. Of 262 patients, 15 (5.7%) referred to an arthritis clinic between January 1979 and July 1981 were subsequently determined to have hypermobility as the basis for their rheumatic complaints. Three of these 15 had concomitant juvenile arthritis. The presenting complaint of pain was most often localized to the knees, hands, and fingers. Arthritis and elevated ESRs were not seen except in the three patients who had concomitant juvenile arthritis. All patients responded to physicial therapy and nonsteroidal analgesic anti-inflammatory drugs. This is an entity not sufficiently well recognized as a source of musculoskeletal complaints in the United States. It will usually respond well to reassurance and symptomatic therapy.

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