Reducing Colon Cancer Risk
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Transcript of Reducing Colon Cancer Risk
Colon cancer is a major public health problem in the United
States.
An ounce of prevention…• Is really worth a pound of cure• The “take home” message tonight is:
– GET YOUR SCREENING COLONOSCOPY!• Easy to do• Proven risk reduction
Known risk factors
• Age• Race• Gender• Family history of colon cancer• Personal history of colon
polyps• Inflammatory Bowel Disease
• Cigarette smoking• Excessive alcohol intake• Obesity• Sedentary lifestyle• Diabetes• Radiation exposure
Age • Advancing age is a major risk factor
– 90% of colon cancers are diagnosed in people over age 50
– Screening recommended for the general population at age 50
Ethnicity• African-American • Ashkenazi Jews
Gender• Males have a higher incidence of adenomas• Studies suggest higher incidence of colon cancer
in men– However, screening guidelines do not currently vary
between men and women
Family history• First-degree relative
– Parent, sibling or child– Cancer or polyps increase risk– Genetic syndromes
• HNPCC (Lynch Syndrome)• FAP • Others
Personal history of polyps• Predisposition to develop malignancy• Closer endoscopic follow-up
Inflammatory Bowel Disease (IBD)• Ulcerative colitis• Crohn’s disease• Require more frequent screening/surveillance
Cigarette smoking• Is noted to be an independent variable for
increasing colon cancer risk
Excessive alcohol intake• Variation in what constitutes “excessive”
– Generally >2 alcoholic beverages per day
Obesity• BMI>25 considered “overweight”• BMI>30 considered “obese”
Sedentary lifestyle• May be related to obesity and other risk factors• Marathon runners can get colon cancer
Diabetes• Major health problem in the United States• Mostly related to obesity and lack of exercise
Diet• Generally thought that a high-fat, low-fiber diet
(think: Horseshoe) increases the risk of developing colon cancer
• Difficult to conduct studies of this nature
Radiation exposure• Particularly, survivors of childhood malignancy
who received abdominal radiation
The random nature of colon cancer
• Approximately 85% of colon cancers are “sporadic” in nature– No family history of colon cancer– “Healthy” patients
Incidence of colon cancer in the U.S.
• 5-6% over a lifetime– So if six Americans out of 100 will get colon cancer
in their lifetime, how can we reduce that risk?
Screening• Tests that aim to prevent the development of colon
cancer– Polyps lead to cancer, and removing polyps stops
that progression• Can be applied to the general population• Screening reduces risk, but does not completely
remove risk
Screening tests• Colonoscopy• Stool studies
– DNA– Occult blood
• Radiographic (XRAY) studies– Barium Enema– “Virtual” Colonoscopy
Double-Contrast Barium Enema• Bowel prep• Liquid barium enema• Insufflation with air via rectum to distend colon• Plain films of colon• Looking for abnormalities
– Narrowing– Polyps
Image of Barium EnemaWebMD, LLC
Advantages of barium enema• No sedation, can drive yourself• Less expensive than colonoscopy
Problems with Barium Enema• Requires bowel preparation• Radiation exposure• Uncomfortable• May be inconclusive, hard to define flat polyps• Colonoscopy needed if abnormality is noted• Negative exam follow-up is five years
Virtual Colonoscopy• a.k.a. CT colonography• Bowel prep• Air insufflation• Read by radiologist• Requires radiation dose for images
Problems• Significant radiation exposure• Uncomfortable• Requires endoscopy if pathology is found• Negative exam follow-up is five years
Stool DNA• Pretty good for detecting cancer• Worse at detecting polyps• Can be done at home• Relatively less expensive
Fecal Occult Blood Testing• Based on concept that colon cancers and large
polyps typically bleed• Must be done annually• Relatively inexpensive• May be done at home• Positive test is indication for colonoscopy
Optical colonoscopy• Still considered the “gold standard”• “One-stop shopping”
– Diagnosis and removal of polyps• High patient satisfaction• Long follow-up period if negative (10 years)• Proven to reduce risk of dying from colon cancer
ColonoscopeZgrumm.com
Negatives• Requires bowel preparation• Typically, requires time off from work• Risks of bleeding, perforation and missed lesions
Nuts and bolts• When to start screening
– Age 50 for most people– Age 40 (or earlier) if first-degree relative with colon
cancer or advanced polyps• When to stop screening
– Over 75 and two negative exams– <5-10 years of reasonable life expectancy
Who performs colonoscopy?• Gastroenterologists• Colon & Rectal Surgeons• Various other non-specialty physicians
How are subspeciality endoscopists different?
• Gastroenterologists/Colon & Rectal Surgeons– Fellowship-trained– High-volume endoscopic practice– Meet accepted standards of care– Springfield Clinic Ambulatory Endoscopy Center
• Designated an ASGE Center of Excellence
Summary• Eating right, exercising regularly and not smoking
are all positive goals for a healthy lifestyle• Prevention of colon cancer relies on effective,
timely screening and surveillance• Colonoscopy is a proven way to reduce colon
cancer risk
How to get a colonoscopy…• See your primary care physician to discuss
screening colonoscopy• Appointment with a subspecialist to discuss the
procedure, bowel preparation and to have questions answered
• Bowel preparation• Procedure day
The outcome• Negative exam (no polyps): return in 10 years for
repeat screening• Polyps
– 3-5 year surveillance colonoscopy depending on number, size and type of polyp(s)
• Other findings– Follow-up and treatment will be discussed
Thank you for your attention.
Questions?