By Maria Perno Goldie, RDH, MS
March was Colorectal Cancer Awareness Month. Even though April has a new focus, it is worth mentioning this devastating disease and discussing its prevention.
Colorectal cancer screening remains low, despite strong evidence that screening prevents deaths. With the aim to make recommended colorectal cancer screening more widespread, an IOM workshop discussed steps to be taken at the clinic, community, and health system levels. On February 25 and 26, 2008, the Forum convened the workshop to discuss screening for colorectal cancer. Learn more about colorectal cancer and prevention in the IOM report.
Implementing Colorectal Cancer Screening - Workshop Summary was released December 11, 2008.(1)
Workshop speakers, representing a broad spectrum of leaders in the field, identified major barriers to increased screening and described strategies to overcome these obstacles. This workshop summary highlights the information presented, as well as the subsequent discussion about actions needed to increase colorectal screening and, ultimately, to prevent more colorectal cancer deaths.
A workshop report is a summary of the presentations and discussions at a workshop. Although authored by a committee, a workshop report contains only the opinions of those who attended and presented at the workshop and does not include consensus findings or recommendations. A workshop report does not reflect the views of the IOM.
A workshop summary is a summary of the presentations and discussions at a workshop. A workshop summary contains only the opinions of those who attended and presented at the workshop and does not include consensus findings or recommendations. A workshop summary does not reflect the views of the IOM.
While research clearly explains how prevention and early detection can save lives, sometimes the translation from the bench to the office is lacking.
Source: Implementing Colorectal Cancer Screening: Workshop Summary, page 4.(1)
Colorectal cancer is the third most common cause of cancer in men and women, and the second leading cause of cancer death in the United States.(2) African Americans have higher incidence and death rates, and are more likely to develop colon cancer at an earlier age than white people.(3, 4)
Astonishingly Japan, which previously had a low incidence of the cancer, is now the country with the highest incidence in men,(4) and Japanese who have emigrated to Hawaii have the highest incidence in the world.(5) This is most likely due to environmental influences on the development of colorectal cancer. The incidence in China and Hong Kong is also increasing rapidly, perhaps due to the adoption of a Western lifestyle and diet (6,7). Environmental factors linked to colorectal cancer include obesity, physical inactivity, intake of red and processed meat, tobacco use, and heavy alcohol intake.(8)
In the United States between 1973 and 1995, incidence declined by 7 percent and continued to decline between 1995 and 2003, while mortality declined by 20 percent between 1985 and 2002 and even more steeply from 2002 to 2004.(9,10) This decline may be linked to increased screening, detection, and removal of adenomas. It is now known that colorectal cancers begin as adenomas that may progress to invasive cancer over 5 to 15 years.(11)
For a fact sheet on colorectal screening and detection, visit the National Cancer Institute.(12) There are professional and patient pages.(13,14) The American Cancer Society has a document: “Colorectal Cancer Early Detection”.(15)
Source: American Cancer Society: Colorectal Cancer Early Detection(16)
Regular screening can often find colorectal cancer early, when it is most likely to be curable. In many cases, screening can also prevent colorectal cancer altogether. This is because some polyps, or growths, can be found and removed before they have the chance to turn into cancer.
If something suspicious is found during a screening exam, or if you have any of the symptoms of colorectal cancer, your physician will probably recommend exams and test to find the cause. Be aware of the signs and symptoms of colorectal cancer!
* A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
* A feeling that you need to have a bowel movement that is not relieved by doing so
* Rectal bleeding, dark stools, or blood in the stool (often, though, the stool will look normal)
* Cramping or abdominal (belly) pain
* Weakness and fatigue
* Unintended weight loss(17)
Most of these symptoms are more often caused by conditions other than colorectal cancer, such as infection, hemorrhoids, or inflammatory bowel disease. However, if you have any of these problems, it's important to see your physician immediately in order for the cause to be determined and treated, if needed.
1. Implementing Colorectal Cancer Screening: Workshop Summary. www.iom.edu/Reports/2008/Implementing-Colorectal-Cancer-Screening-Workshop-Summary.aspx
2. ACS (American Cancer Society). 2007a. Cancer facts & figures. Atlanta, GA: American Cancer Society.
3. NCI. 2007. SEER Cancer Statistics Review, 1975–2004, edited by L. A. G. Ries, D. Melbert, M. Krapcho, A. Mariotto, B. A. Miller, E. J. Feuer, L. Clegg, M. J. Horner, N. Howlader, M. P. Eisner, M. Reichman, and B. K. Edwards. Bethesda, MD: NCI, seer.cancer.gov/csr/1975_2004/, based on November 2006 SEER data submission, posted to the SEER web site, 2007 (accessed March 5, 2012).
4. Parkin, D. M., F. Bray, J. Ferlay, and P. Pisani. 2005. Global cancer statistics, 2002. CA: A Cancer Journal for Clinicians 55(2):74–108.
5. Sakamoto, K., J. Machi, M. Prygrocki, T. Watanabe, S. Hosoda, M. Sugano, Y. Tomiki, and T. Kamano. 2006. Comparison of characteristics and survival of colorectal cancer between Japanese-Americans in Hawaii and native Japanese in Japan. Diseases of the colon and rectum 49(1):50–57.
6. Sung, J. J. Y., J. Y. W. Lau, M. D. Goh, and W. K. Leung. Increasing incidence of colorectal cancer in Asia: Implications for screening. The Lancet Oncology 6(11):871–876.
7. Vainio, H., and A. B. Miller. 2003. Primary and secondary prevention in colorectal cancer. Acta Oncologica 42(8):809–815.
8. Koushik, A., D. J. Hunter, D. Spiegelman, W. L. Beeson, P. A. v. d. Brandt, J. E. Buring, E. E. Calle, E. Cho, G. E. Fraser, J. L. Freundenheim, C. S. Fuchs, E. L. Giovannucci, R. A. Goldbohm, L. Harnack, J. D. R. Jacobs, I. Kato, V. Krogh, S. C. Larsson, M. F. Leitzmann, J. R. Marshall, M. L. McCullough, A. B. Miller, P. Pietinen, T. E. Rohan, A. Schatzkin, S. Sieri, M. J. Virtanen, A. Wolk, A. Zeleniuch-Jacquotte, S. M. Zhang and S. A. Smith-Warner. 2007. Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies. Journal of the National Cancer Institute 99(19):1471–1483.; Wolin, K. Y., I. M. Lee, G. A. Colditz, R. J. Glynn, C. Fuchs, and E. Giovannucci. 2007. Leisure time physical activity patterns and risk of colon cancer in women. International Journal of Cancer 121(12):2776–2781.
9. NCI (National Cancer Institute). 2004. SEER Cancer Statistics Review, 1975–2002, edited by L. A. G. Ries, M. P. Eisner, C. L. Kosary, B. F. Hankey, B. A. Miller, L. Clegg, A. Mariotto, E. J. Feuer, and B. K. Edwards. Bethesda, MD: NCI, seer.cancer.gov/csr/1975_2002/, based on November 2004 SEER data submission, posted to the SEER web site, 2005 (accessed March 5, 2012).
10. NCI. 2006. SEER Cancer Statistics Review, 1975–2003, edited by L. A. G. Ries, D. Harkins, M. Krapcho, A. Mariotto, B. A. Miller, E. J. Feuer, L. Clegg, M. P. Eisner, M. J. Horner, N. Howlader, M. Hayat, B. F. Hankey, and B. K. Edwards. Bethesda, MD: NCI, seer.cancer.gov/csr/1975_2003/, based on November 2005 SEER data submission, posted to the SEER web site, 2006 (accessed March 5, 2012).
11. Young, G. P., P. Rozen, and B. Levin. 2002. How does colorectal cancer develop? In Colorectal
cancer in clinical practice: Prevention, early detection and management, edited by P. Rozen,
G. Young, B. Levin, and S. Spann. London, England: Martin Dunitz, Ltd. Pp. 23–37.
12. www.cancer.gov/cancertopics/factsheet/detection/colorectal-screening. (accessed March 5, 2012).
13. www.cancer.gov/cancertopics/pdq/screening/colorectal/HealthProfessional. (accessed March 5, 2012).
14. www.cancer.gov/cancertopics/pdq/screening/colorectal/Patient. (accessed March 5, 2012).
15. www.cancer.org/acs/groups/cid/documents/webcontent/003170-pdf.pdf. (accessed March 5, 2012).
16. www.cancer.org/acs/groups/cid/documents/webcontent/003170-pdf.pdf. (accessed March 5, 2012).
17. www.cancer.org/acs/groups/cid/documents/webcontent/003170-pdf.pdf. (accessed March 5, 2012).
Maria Perno Goldie, RDH, MS
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