CRC Screening symposium --March 20.2010; Sacramento California
CRC Prevention and Screening
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Transcript of CRC Prevention and Screening
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Departments of Nursing/Health, Nutrition and Exercise Sciences
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Objectives
Review guidelines to prevent colorectal cancer (CRC) with “healthy living”
Review screening recommendations for CRC
Encourage discussion of CRC screening at physician appointments
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Cancer DeathsNorth Dakota
Cancer (all types) second-leading cause of death
Colorectal cancer ranks second Lung Cancer 1st Colorectal Cancer 2nd Breast Cancer 3rd Prostate Cancer 4th
www.cdc.gov/cancer/CancerBurden/nd.htm
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Preventable and treatable Colorectal cancer
On average, 13 years of life lost 93% of cases in people over 50 75% of cases in people of
average risk
“The disease no one has to die from.”
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What is the “prescription” for healthy living?
Don’t smoke Eat a healthy diet Maintain a healthy weight Exercise regularly Limit alcoholic beverages
Helps prevent cancer, heart disease and diabetes
Eyre H et al. Cancer J Clin. 2004;54:190-207. Byers T et al., CA Cancer J Clin 2002;52:92-119.
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Smoking Increases CRC risk
1. Stop smoking!
Tobacco use Single largest preventable cause of
disease and premature death in the U.S.
Smoking Shown to cause CRC and 13 other
cancers
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The New American PlateAmerican Institute of Cancer Research
Meal patterns for a healthful life!
Vegetables1½ cups
Milk8 fl. oz.
Meat, Beans, Seeds2-3 oz. equivalents
Fruits½ cup
Whole Grains2 oz. equivalents
www.aicr.org
Healthy Oils2 tsp. equivalents
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Emphasize Plant SourcesReduces risk of CRC
Include fruits and vegetables
Dietary Guidelines 1½-2 cups fruits 2½-3 cups vegetables
Include whole grains, beans, seeds and nuts
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Meat Variety and ModerationReduces risk of CRC
Follow Dietary Guidelines Include a variety of lean
meat/protein sources Use smaller portions for a
total of 5-6½ oz./day
Limit high-fat, processed meats
Limit cooking at high temperatures Suggest braising, steaming, poaching,
stewing, microwaving meats
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Calcium and Vitamin D Reduces risk of CRC
Vitamin D -“sunshine vitamin” Produced in the skin in sunlight
Calcium sources Dairy products (milk, yogurt, cheese) Fortified grains and orange juice Calcium supplements
Fortified fluid milkMost reliable daily source for both
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Folic Acid Reduces risk of CRC
Include food sources
Fortified breakfast cereals Enriched grain products Orange juice and other fruits Green, leafy vegetables Beans, nuts and seeds
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SeleniumReduces risk of CRC
Include food sources
Protein-rich foods (meats, fish, beans, seeds, breads and cereals, milk)
Content of food varies depending on the selenium content of soil
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Alcohol Moderation reduces risk of CRC
Limit alcohol intake Women - One drink or less per day Men - Two drinks or less per day
CRC risk increases substantially More than two drinks per day
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Maintain a Healthy Weight Reduces risk of CRC
Overweight and Obesity
Associated with up to 2/3 of all cancers
Associated with a greater risk for colon cancer
North Dakota statistics More than 60% of adults either overweight or obese
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Physical Activity (PA)Reduces risk of CRC
Recommend 30 minutes or more 5 or more days each week
Best reduction of risk 45 minutes or more of moderate
to vigorous PA 5 or more days each week
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ScreeningReduces risk of CRC
Early detection and removal of polyps provides a greater than 90% cure rate!
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CRC Screening Methods - Age 50+
Annual - Fecal Occult Blood Test -OR
Every 5 years - Flexible Sigmoidoscopy-OR
Combination of tests Annual - Fecal Occult Blood Test Every 5 years - Flexible Sigmoidoscopy
-OR
Every 10 years - Colonoscopy-OR
Every 5 years - Double Contrast Barium Enema
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Fecal Occult Blood Test (FOBT)CRC screening procedure
FOBT detects blood in stool Polyps and CRC can bleed slowly Blood “hidden” in the stool
Convenient - done at home
Costs $3.50 Medicare pays Most health insurances cover cost
Ouyang DL et al., Am J Gastroenterol. 2005;100:1393-1403.
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Endoscope ProceduresVisualization of the colon
Flexible sigmoidoscopy
Examines lower third
Colonoscopy Examines entire length
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Double Contrast Barium EnemaCRC screening procedure
Barium added to the enema solution
X-rays taken of colon Barium outlines lining of the colon
to detect polyps or abnormalities Suggested once every 5 years
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What are polyps?
Start small and grow larger over time
May bleed into the colon
Use FOBT to check
May become cancerous
David M. Martin, M.D. and Atlanta South Gastroenterology, P.C. - www.endoatlas.com
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Removal of polypsOutpatient endoscope procedure
Visualize May appear like a
mushroom on a “stalk”
Remove with a wire loop Painless Takes only minutes
Analyze To determine if cancerous
Benign polyp (noncancerous)
David M. Martin, M.D. and Atlanta South Gastroenterology, P.C. - www.endoatlas.com
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Early cancerous polyps Cured by wire loop
David M. Martin, M.D. and Atlanta South Gastroenterology, P.C. - www.endoatlas.com
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Screening statisticsNorth Dakota (Age 50+)
FOBT in past two years — 21%
Ever had a sigmoidoscopy or colonoscopy — 54%
Screening needed for early detection!
http://apps.nccd.cdc.gov/brfss (2004)
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People at high risk for CRCStart screening before age 50
Personal or family history
Polyps or colorectal cancer
Ulcerative colitis or Crohn’s disease
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Ask your doctor!Arrange to be screened for CRC
Now that I’m 50, what tests for cancer should I have?
I’ve read that there’s more than one test for colon cancer. Which one do you think is right for me?
www.cancer.org
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Symptoms of late CRCSee your doctor for a diagnostic workup!!!
A change in bowel habits
Diarrhea or constipation
Feeling the bowel does not completely empty
Vomiting
Abdominal discomfort (gas, bloating, cramps)
Weight loss for no known reason
Unexplained anemia
Any blood in the stool - merits a follow-up!
(Do not assume blood is from hemorrhoids)
Symptoms persisting for more than two weeks
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Late CRCOnly an 8% survival rate
David M. Martin, M.D. and Atlanta South Gastroenterology, P.C. - www.endoatlas.com
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Screening saves lives!
More than 90% of CRC deaths are preventable
With healthy lifestyles
With removal of benign or precancerous polyps
With early detection of cancer and treatment
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Thank you! Developed by
Beverly Greenwald, PhD, RN
Assisted by Jane U. Edwards, PhD, LRD