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Rectal Cancer - Screening/Prevention
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Early Morning Colonoscopies Detect More Polyps (11/13/2009)
Researchers affiliated with the Veterans Administration of greater Los Angeles have reported that a greater number of polyps was detected among patients seen early in the morning than among patients seen later in the day. The reasons for this are uncertain, but it’s possible that the lower rate of polyp detection later in the day is the result of provider fatigue or less complete bowel preparation. These results were published in November, 2009 issue of Clinical Gastroenterology and Hepatology.
Israeli Jewish Holocaust Survivors May Have Increased Risk of Cancer (11/12/2009)
Researchers from Israel have reported that the incidence of all cancers, and especially breast and colorectal cancers, is higher among Israeli Jews who were potentially exposed to the Holocaust compared with those who were not. The details of this study were published in the November 4, 2009 issue of the Journal of the National Cancer Institute.
Daily Aspirin May Decrease Risk of Colorectal Cancer in Lynch Syndrome (10/7/2009)
Researchers involved in the international multi-institutional study, CAPP2, have reported that the use of daily aspirin may reduce the incidence of colorectal adenomas and cancers in individuals with hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch Syndrome. The details of this study were presented on September 21, 2009 at Europe’s largest cancer congress, ECCO 15-ESMO 34, in Berlin.
False-positive Results Are Common with Cancer Screening (7/21/2009)
Researchers affiliated with the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial have reported that the risk of obtaining a false-positive result from screening for prostate, lung, colorectal, and ovarian cancer is high and becomes cumulatively higher with ongoing screening—after 14 screening tests, the cumulative risk of a false-positive is 60.4% for men and 48.8% for women. The results of this study were published in the May/June 2009 issue of the Annals of Family Medicine.
Meta-analysis Confirms that Diet and Lifestyle Choices Are Key to Preventing Colorectal Cancer (7/10/2009)
Researchers from Australia have reported that exercise, diet, and lifestyle choices are key factors in preventing colon cancer. The details of this study were published in the July 1, 2009 issue of the International Journal of Cancer.
Age and Illness Increase Colonoscopy Risks (6/22/2009)
Researchers from the National Cancer Institute and the University of North Carolina have reported that the risk of complications from colonoscopy is increased in the very elderly and in those with certain chronic health conditions. The results of this study were published in the June 16, 2009 issue of the Annals of Internal Medicine.
Coffee Does Not Decrease Risk of Colorectal Cancer (5/5/2009)
Researchers from the Harvard School of Public Health have reported that, contrary to the results of several previous studies, coffee consumption does not appear to reduce the risk of colorectal cancer. The details of this study were reported in the April 1, 2009 issue of the International Journal of Cancer.
Meta-analysis Confirms that Aspirin Helps Prevent Colorectal Adenomas (3/17/2009)
An international group of researchers have reported that daily use of aspirin may reduce the risk of colorectal adenomas, especially advanced lesions. The details of this study appeared in the February 2009 issue of the Journal of the National Cancer Institute.
Moderate Alcohol Consumption Increases Risk of Cancer in Women (3/13/2009)
Researchers from the UK have reported that women who regularly consume low to moderate amounts of alcohol have an increased risk of cancers of the upper digestive tract, rectum, liver, and breast when compared with women who do not drink. The results of this study were published in the March 4, 2009 issue of the Journal of the National Cancer Institute.
Mailed Reminders Promote Colorectal Cancer Screening (3/2/2009)
Researchers from Harvard University have reported that mailed reminders improve colorectal cancer screening rates. The details of this study appeared in the February 23, 2009 issue of the Archives of Internal Medicine.
Calcium Rich Diet May Reduce Colorectal Cancer Risk (2/26/2009)
Researchers from the National Cancer Institute have reported that high calcium intake is associated with a “lower risk of total cancer and cancers of the digestive system, especially colorectal cancer.” The details of this study appeared in the February 23, 2009 issue of the Archives of Internal Medicine.
Colorectal Cancer FOBT Screening Reduces Mortality (2/26/2009)
Researchers from Italy have reported that the implementation of colorectal cancer screening by a fecal occult blood test (FOBT) appears to reduce mortality, as evidenced by the disparity between mortality rates among regions that implemented FOBT screening at different times. The results of this study were published in the December 17, 2008 issue of the Journal of the National Cancer Institute.
Aspirin and/or Resistant Starch Have No Effect on Colorectal Cancer Incidence Among People with Lynch Syndrome (2/23/2009)
Researchers involved in an international multi-institutional study have reported that the use of aspirin and/or resistant starch has no effect on the incidence of colon cancer among individuals with Lynch Syndrome. The details of his study were published in the December 11, 2008 issue of the New England Journal of Medicine.
Newer Immunochemical Fecal Occult Blood Tests Confirmed More Reliable Than Older Guaiac Tests for Detection of Colorectal Cancer (2/17/2009)
Researchers from Germany have reported that immunochemical tests for fecal blood are more accurate than the older guaiac test but different immunochemical tests have significant variability in accuracy. The details of this study were reported in the February 3, 2009 issue of the Annals of Internal Medicine.
Postmenopausal Hormones Reduce the Risk of Colorectal Cancer (2/4/2009)
Researchers from the University of Minnesota have reported that the use of postmenopausal hormones reduces the risk of colorectal cancer for women. The details of this study appeared in the January 1, 2009 issue of Cancer Epidemiology, Biomarkers, & Prevention.
Vitamin D Prevents Colorectal Adenomas (11/10/2008)
Researchers from several U.S. medical institutions have reported that higher circulating 25-hydroxyvitamin D serum levels and high vitamin D intake are associated with a decreased incidence of colorectal adenomas and recurrent adenomas. The details of this meta-analysis were published in the November 1, 2008 issue of Cancer Epidemiology Biomarkers and Prevention.
Vitamin Supplementation Has No Effect on Cancer Risk in Women (11/6/2008)
Researchers affiliated with the Women’s Antioxidant and Folic Acid Cardiovascular Study reported that supplementation with folic acid, vitamin B6, and B12 has no impact on the incidence of cancer. The details of this study appeared in the November 5, 2008 issue of the Journal of the American Medical Association.
Primary Physicians are not Recommending Cancer Screening of Medicaid Recipients (10/28/2008)
Researchers from the University of North Carolina have reported that primary care physicians were not recommending cancer screening for colorectal, breast and cervical cancer for half of the eligible patients. The details of this study appeared in the October 13, 2008 issue of the Archives of Internal Medicine.
United States Preventive Task Force Provides Recommendations for Colorectal Cancer Screening (10/14/2008)
The United States Preventive Services Task Force (USPSTF) has recently issued recommendations for the screening of colorectal cancer. These recommendations were published October 7, 2008 in an early online publication in the Archives of Internal Medicine.
Risk of Colon Cancer Associated with Genetic Variants (10/9/2008)
Researchers from several medical centers have reported that genetic changes in the surrounding region of the ADIPQ gene are associated with a decrease in the risk of developing colorectal cancer. Results such as these may aid in the understanding of genetic risk of various cancers, ultimately changing the way in which cancer is managed. These results were recently published in the October 1, 2008 issue of the Journal of the American Medical Association.
African Americans Have More Colon Polyps on Screening Colonoscopy than Whites (9/25/2008)
Researchers from Oregon Health and Science University have reported that African-American men and women have a higher risk of larger polyps than White persons. The details of this study appeared in the September 24, 2008 issue of the Journal of the American Medical Association.
Study Confirms Utility of CT Colonography Screening (9/19/2008)
Researchers involved in a U.S. multicenter trial comparing CT colonoscopy with optical colonoscopy have concluded that CT colonography is accurate enough to be used as a routine screening technique in persons at average risk of developing colon cancer. The details of this study appeared in the September 18, 2008 issue of the New England Journal of Medicine.
Incidence of Advanced Adenomas Low with a Rescreening Interval of Five Years (9/18/2008)
Researchers affiliated with the Lilly Colorectal Cancer Prevention Program have reported that the risk of colorectal cancer five years after a screening colonoscopy is very low. The details of this study appeared in the September 18, 2008 issue of the New England Journal of Medicine.
Management of Colonoscopic Perforations Described (8/7/2008)
Researchers from the Mayo Clinic have reported that “Colonoscopic perforation occurs in fewer than 1 in 1000 patients and is associated with significant morbidity and mortality.” The details of this retrospective review were published in the July 2008 issue of the Archives of Surgery.
Non-invasive Test Effective for Colorectal Cancer Screening (6/9/2008)
A new, non-invasive colorectal cancer screening test from Exact Sciences is now available and supported by the American Cancer Society and other major medical groups. Study results showing the test’s efficacy have been reported in the April 2008 supplement of Gastroenterology.
Physicians with More Training Perform More-effective Colonoscopies (5/8/2008)
Researchers from Korea have reported that a physician must perform at least 150 colonoscopies to be considered competent at the procedure. Details of the study were recently published in the April 2008 issue of Gastrointestinal Endoscopy.
Celebrex® Reduces Colon Adenomas (4/25/2008)
Researchers affiliated with the APC trial (Adenoma Prevention Celebrex) have reported that Celebrex® (celecoxib) reduces the rate of colon adenomas at five years and appears safe, even among patients with cardiovascular disease. These results were recently presented as a late-breaking abstract at the 2008 annual meeting of the American Association for Cancer Research, April 12-16, in San Diego.
Drug Combination Decreases Recurrence Rate of Colon Polyps (4/22/2008)
Researchers from the University of California Irvine have reported that the combination of the difluoromethylornithine (DFMO) and sulindac reduces the rate of colon adenomas by up to 95% among patients who have had prior colon polyps. These results were presented as a late-breaking abstract at the 2008 annual meeting of the American Association for Cancer Research held in San Diego, April 12-16, 2008.
CT Colonography Screening Deemed Cost Effective (4/21/2008)
Researchers from the United States and Italy have reported that the ability of computerized tomographic colonography (CTC) to detect abdominal aortic aneurisms and extracolonic cancers in addition to premalignant and malignant colonic neoplasms makes this technique cost effective as compared with colonoscopy or colonoscopy plus ultrasonography. The details of this study appeared in the April 14, 2008 issue of the Archives of Internal Medicine.
U.S. Capacity Deemed Adequate for Large Scale CT Colonography Screening (4/9/2008)
Researchers from the University of Wisconsin have reported that, at 64, there is an adequate number of slice multi-detector computed tomography (MDCT) systems in the Unites States for mass screening by CT colonography (CTC). The details of this study were published in the April 2008 issue of the American Journal of Roentgenology.
NonPolypoid Colorectal Neoplasms Common and More Malignant than Polypoid Lesions (3/12/2008)
Researchers from the Veteran’s Affairs Palo Alto Health Care System have reported that nonpolypoid colorectal neoplasms are more common than polypoid neoplasms and are almost 10 times more likely to be malignant. The details of this study appeared in the March 5, 2008 issue of the Journal of the American Medical Association.
Smoking Increases Risk of Rectal Cancer (12/3/2007)
Researchers involved in the Women’s Health Initiative (WHI) have reported that smoking increases the risk of developing rectal cancer. The details of this study appeared in the November 20, 2007 issue of the Journal of the National Cancer Institute.
MRI Predicts Curative Resection of Rectal Cancer (10/20/2006)
Physicians from 20 colorectal clinics in four European countries affiliated with the MERCURY study group have reported that high resolution magnetic resonance imaging (MRI) accurately predicts rectal cancers that can be completely or incompletely resected.
African-Americans Encouraged to Begin Colorectal Cancer Screening at Age 45 (4/5/2005)
The American College of Gastroenterology has recently recommended that African-Americans initiate colorectal cancer screening at the age of 45 years instead of age 50 years, which is the recommendation for Caucasian and Asian populations. The details of this report and an extensive bibliography on this subject were published in the March 2005 issue of the American Journal of Gastroenterology.
Night-Shift Workers at Higher Risk for Colorectal Cancer (6/17/2003)
In the June 4 2003 issue of the
Journal of the National Cancer Institute, researchers affiliated with the Nurses’ Health Study have reported a possible 35% increase in the incidence of colorectal cancer in long-term night shift workers.
Cetuximab (Erbitux®) And Camptosar® More Effective Than Cetuximab Alone For Colorectal Cancer (6/10/2003)
In an oral session of the 39th annual meeting of the American Society of Clinical Oncology in June of 2003, researchers from Europe reported that the combination of Erbitux® plus Camptosar® more than doubled the response rate in Camptosar® refractory epithelial growth factor receptor (EGFR)-positive colorectal cancer patients. compared to Erbutux® alone. Erbitux® is a monoclonal antibody that binds to the extracellular domain of EGFR, competitively inhibiting the binding of extracellular ligand. When Erbitux™ is bound, it appears to stimulate internalization of EGFR.
Antiangiogenic Drug, Bevacizumab (Avastin"), Improves Response of Colorectal Cancer to Combination Chemotherapy (6/10/2003)
At the 2003 meeting of the American Society of Clinical Oncology, Dr. Herbert Hurwitz from Duke University Medical Center presented the results of a randomized multi-center trial demonstrating the effectiveness of Avastin™ plus combination chemotherapy for the treatment of metastatic colorectal cancer. This paper was presented as a late breaking oral presentation and the abstract has not yet been published. The summary of this study was published in the ASCO Daily News for June 2, 2003.
Beta Carotene Increases Colorectal Adenoma Incidence in Smokers and Drinkers but is Preventative in Abstainers (5/21/2003)
Researchers from Dartmouth, USC, University of Minnesota, and the Cleveland Clinic reported in the May 21, 2003 issue of the
Journal of the National Cancer Institute that supplementation with beta carotene increased the incidence of colorectal adenomas in smokers and drinkers but decreased incidence in abstainers.
Rectal Cancer Outcomes Improve when Institutions Treat More Patients (5/21/2003)
Researchers reported an inverse relationship between the number of patients treated for rectal cancer and outcome as measured by permanent colostomies, 30 day survival, and 2 year survival. These results are based on analysis of data from California hospitals and were published in the May 21, 2003 issue of the
Journal of the National Cancer Institute. (1)
Screening Sigmoidoscopy Can Reduce Risk of Distal Colo-Rectal Cancer by 76% (4/16/2003)
Researchers from the Fred Hutchinson Cancer Research Center, Seattle, WA. Have determined that screening sigmoidoscopy can reduce the incidence of colorectal cancer by approximately 76%. They reported their results in the April 16 2003 issue of the
Journal of the National Cancer Institute.
Acceptability of Genetic Testing for Hereditary Nonpolyposis Colorectal Cancer (4/15/2003)
Mutations of specific genes increase the risk of cancer. However, the body has a built in repair mechanism to correct most mutations before cancer develops. The body’s DNA mismatch repair system recognizes one type of mutation and corrects it by substituting the right chemical structures in the gene. However, there can be mutations of the genes of the repair system.
Randomized Trials Confirm Benefit of Aspirin in Preventing Colorectal Adenomas (3/13/2003)
There have been several retrospective comparative studies suggesting that aspirin may lower the risk of colorectal cancer by decreasing the formation of precursor adenomas. These studies were based on information provided by individuals concerning aspirin intake and these data were correlated with the incidence of colorectal cancer. In addition to these, epidemiology studies in animals have also suggested that aspirin has a chemopreventive effect in preventing adenomas. In the March 6, 2003 issue of the
New England Journal of Medicine, the results of two randomized trials were presented which documented the effects of aspirin in preventing colorectal adenomas.
Relative Risks of Colonoscopy and Sigmoidoscopy Defined (2/13/2003)
It is currently recommended that all persons over the age of 50 years who are at average risk for colon cancer have screening for colon cancer with biannual testing for fecal occult blood and a sigmoidoscopy every 5 years. However, sigmoidoscopy can only detect polyps and cancers in the lower 40% of the bowel while colonoscopy visualizes the entire colon. There has been reluctance to advise the use of colonoscopy as a routine screening procedure due to the increased risks involved in this procedure. Colonoscopy is performed in the operating room under heavy sedation or anesthesia and has more complications, especially perforation which can lead to death, than sigmoidoscopy. Although the risk of perforation from colonoscopy in the hands of a skilled physician is considered small, it is admitted by most reviewers who have evaluated this issue that there are not enough skilled physicians in the U.S. to make colonoscopy a practical screening procedure for everyone. Thus, physicians and patients need to make choices about screening procedures.
Randomized Trial Does Not Show Benefit For Intra-Arterial Chemotherapy For Colorectal Cancer Metastatic to Liver (2/3/2003)
The liver is the most frequent site of metastasis for patients with colorectal cancer and is the second most frequent cause of cancer death in this patient population. There have been a variety of treatments used for the majority of patients with colorectal cancer metastatic to the liver who are inoperable, including: intravenous chemotherapy, intra-arterial chemotherapy, interferon-alfa, conformal radiation therapy, radioactive lipitiol, liver transplantation, embolization, chemoembolization, cryotherapy, radiation-delivering microspheres and radiofrequency ablation. The most commonly used methods are intravenous chemotherapy with 5-FU and folinic acid or the same drugs administered intra-arterially. There are theoretical reasons to suggest that direct intra-arterial chemotherapy should be more effective and less toxic than intravenous administration. However, intra-arterial infusions require placement of a catheter into the hepatic artery and maintenance of this catheter for the duration of treatment.
Insurance not a Factor in Low Rate of Screening for Colorectal Cancer (1/9/2003)
Colorectal cancer is the second leading cause of death in the United States. Screening is thought to be very important for the prevention and early treatment of colorectal cancer in average risk individuals. It is currently recommended that all patients over the age of 50 be screened regularly for colorectal cancer. Additionally, people with a personal or family history of adenomatous polyps or colorectal cancer may begin screening much earlier.
Bevacizumab (Avastin"), a Monoclonal Antibody Against Vascular Endothelial Growth Factor (VEGF), Active in Colon Cancer (1/6/2003)
There is compelling evidence that angiogenesis plays a major role in the growth and spread of many cancers. Vascular endothelial growth factor (VEGF) is a factor that regulates normal and pathologic angiogenesis and has been implicated in the growth or several types of cancer including colon cancer. These observations have led to the development of antibodies that inhibit VEGF. There is evidence from animal models that anti-VEGF antibodies and chemotherapy are more effective than either modality alone. Avastin" is a recombinant humanized monoclonal antibody to VEGF which is currently being tested in number of clinical trials.
Further Evidence That a High Dietary Fiber Diet Does Not Prevent Recurrence of Colon Polyps (11/7/2002)
In non-randomized trials, it has been suggested that diets high in bran fiber and low in fats prevent the development of colon cancer by preventing the development of adenomatous polyps. Similar findings have been made in regard to diets high in fiber from fruits and vegetables. In 2000, the Phoenix Colon Cancer Prevention Network published results of a randomized trial casting doubt on these observations.
1
In this study, published in The New England Journal of Medicine, the researchers randomly allocated 1,429 men and women, ages 40 to 80 years, who had previously had one or more colorectal adenomatous polyps to receive a high-fiber wheat bran dietary supplement or a low-fiber wheat bran dietary supplement. The results demonstrated that approximately 50% of persons from both groups developed additional polyps. It was concluded that a dietary supplement of wheat bran did not reduce the risk for developing pre-cancerous adenomatous polyps of the colon and rectum.
U.S. Preventive Services Task Force Issues Recommendations for Hormone Replacement Therapy (10/23/2002)
On October 15, the U.S. Preventive Services Task Force (USPSTF) issued guidelines for hormone replacement therapy. This document was prepared after the recent publications which cast doubt on the benefits of women taking hormonal therapy after menopause. These recommendations can be reviewed in total at http://www.preventiveservices.ahrq.gov and http://www.guideline.gov. This is the first update since 1996.
Motexafin Gadolinium (Xcytrin®) Improves Results of Whole Brain Radiation Therapy in Patients with Cancer Metastatic to Brain (10/14/2002)
Cancers often consist of areas of low oxygen concentration which complicates treatment. Hypoxic cells are more resistant to the effects of radiation than well-oxygenated tissues and there have been many candidate drugs for increasing oxygenation of cancers (radiosensitizers), none of which have been very successful. Xcytrin® (motexafin gadolinium) is a new type of radiation sensitizer that sensitizes both oxygenated and hypoxic cells to the effects of radiation. Xcytrin® also localizes selectively in tumors and this can be detected by magnetic resonance imaging (MRI). Laboratory and preclinical studies suggested that Xcytrin® could potentiate the effects of radiation for the treatment of cancers. In 1999, researchers at the University of Pennsylvania determined the optimal dose of Xcytrin® that could be given to patients with a variety of cancers receiving radiation therapy in a phase I trial.
1
Temodol® Improves the Response Rate to Radiation Therapy for Cancer Metastatic to Brain (10/11/2002)
Temozolomide (Temodol®) is an analog of the alkylating agent procarbazine which has been approved by the U.S. Food and Drug Administration for the treatment of recurrent brain tumors. Current research with this drug primarily involves treatment of newly diagnosed brain tumors. However, researchers in Greece have evaluated the effectiveness of Temodol® for the treatment of cancer metastatic to brain. At the 2002 meeting of the American Society for Therapeutic Radiology and Oncology, the researchers reported that the addition of Temodol® to whole-brain radiation therapy resulted in significantly higher response rates of brain metastases compared to whole brain radiation alone.
National Colorectal Cancer Roundtable Publishes Strategy For Prevention of Colorectal Cancer (10/9/2002)
The National Colorectal Cancer Roundtable (NCCRT) was founded in 1997 by the American Cancer Society and the Centers for Disease Control and Prevention. The goal of this organization is to promote methods of preventing colorectal cancer. In the October 2002 issue of
Cancer, these researchers presented a summary of the failure of the U.S. population to take advantage of screening methods of detecting early pre-cancerous lesions of the bowel. They point out that screening methods could reduce the 56,600 deaths per year from colorectal cancer by 50%. They estimate that the life-time risk of the population for developing colorectal cancer is 6%.
Stereotactic Radiosurgery Following Whole Brain Radiation Therapy Improves Palliation of Patients with Cancer Metastatic to Brain (10/8/2002)
Whole brain radiation therapy (WBRT) is the most frequent palliative modality for patients with cancer metastatic to the brain. Stereotactic radiosurgery (SRS), also called gamma knife therapy or 3-dimensional radiation therapy, can deliver precise doses of radiation to tumor sites while sparing normal tissue. Stereotactic techniques are used to treat a variety of cancers and are widely accepted as superior to non-precise radiation techniques. Since 1996, researchers from 34 medical institutions affiliated with the Radiation Therapy Oncology Group have been carrying out a study to document the benefits of SRS in individuals with cancers that are metastatic to the brain. They have concluded from this study that SRS adds significantly to the palliation achieved with WBRT alone. They reported these results at a plenary session of the annual meeting of the
American Society of Therapeutic Radiology and Oncology in October of 2002.
Intraspinal Implantable Drug System Effective in Controlling Pain Due to Metastatic Cancer (10/1/2002)
The management of pain is an important component for the treatment of most patients with metastatic cancer. It is estimated that 5-15% of patients with metastatic cancer have pain that is refractory to oral and i.v. narcotics. Intraspinal implantable drug delivery systems (IDDSs) deliver small doses of morphine directly to the spinal fluid, theoretically requiring smaller doses of narcotics. Although this system is known to be effective, there have been no randomized controlled trials. Researchers in the U.S. and Europe affiliated with the Implantable Drug Delivery Systems Study Group have determined that IDDSs are better than conventional pain management techniques. They reported these results in the October 2002 issue of the
Journal of Clinical Oncology.
Further Evidence that Adjuvant Therapy is Effective in Elderly Stage III Colon Cancer Patients (10/1/2002)
Randomized trials have clearly demonstrated that adjuvant chemotherapy improves survival in patients with stage III colon cancer by approximately 30%. However, few elderly patients are entered on these randomized trials and it has not been certain that such patients benefit from adjuvant therapy. This issue is of particular interest since the incidence of colon cancer is 11 times higher in patients over 65, compared to those who are younger. In a review of 7 separate clinical trials that were conducted to evaluate adjuvant chemotherapy in patients with stage II or III colon cancer, there were no differences in survival rates between older and younger patients
1
. A second single institution study concluded that age was not a predictor of relapse or overall survival in patients receiving adjuvant chemotherapy for stage II-III colon cancer
2
. Researchers from the University of Pennsylvania and the Pritzker School of Medicine have used information from the Surveillance, Epidemiology, and End-Results (SEER)-Medicare data to evaluate the effects of adjuvant therapy for stage III colon cancer in elderly patients
3
. The results of this analysis were published in the October 2002 issue of the
Journal of Clinical Oncology.
Dutch Prospective Study Confirms Increased Risk of Colorectal Cancer with Low Dietary Folate Intake (9/24/2002)
An adequate intake of folic acid is achieved by eating fresh fruits and vegetables. In previous retrospective studies, researchers have documented an approximate 35% increase in the risk of colorectal cancer in persons who consume the lowest amount of folic acid, compared to persons who consume the highest amount of folic acid. These observations have led to three large ongoing clinical trials evaluating chemoprevention of colorectal cancer with folic acid supplements. In the September 2002 issue of Cancer, Dutch researchers report the first prospective study of dietary folic acid intake on the incidence of colon and rectal cancer. This study started in 1986 and has a 7.3 year follow-up. Since 1986, the researchers have followed 120,852 men and women aged 55-69 years. There were 760 colon cancers and 411 rectal cancers during the follow-up period. For men and women, the risk of colon cancer was reduced by 27% in persons with the highest folic acid intake, compared to the lowest intake. For rectal cancer there were no differences in women, but men with high folic acid intake had a 34% reduction of cancer rates. The researchers found no differences in outcomes when they analyzed for the form of folic acid (i.e. whether it was in the form of polyglutamates or monoglutamates). They also found suggestive evidence that men who consume higher amounts of alcohol combined with inadequate intakes of folate and methionine are at a higher risk of developing rectal carcinoma.
Swiss Study Confirms Ability of Virtual Colonoscopy to Detect Lesions 10 mm or Greater in Size (9/5/2002)
Virtual colonoscopy, also called colonography, is a technique that uses rapid computerized tomography (CT) scanning with conventional or electron beam (EB) machines combined with sophisticated computer programs. Patients undergoing virtual colonoscopy have the same extensive bowel purging as those undergoing actual colonoscopy and have the same insufflation of air to outline the bowel. The important part of this approach is the computer programs that can produce images of the colon that mimic an actual colonoscopy. Virtual colonoscopy has been evaluated more and more over the past several years in order to determine how virtual colonoscopy compares to actual colonoscopy. This is important since actual colonoscopy is the best way to detect and monitor pre-malignant polyps, but is limited by the need for heavy sedation or anesthesia and a small but definite risk of perforation of the bowel. In addition, there are not enough skilled physicians to perform colonoscopy on all individuals who should have it done for screening for colon cancer. A previous study from the U.S. clearly demonstrated that almost all lesions in the colon that were 10 mm or greater could be detected by virtual colonoscopy, but not smaller lesions.
Lack of Benefit and Potential Harm Halts Clinical Trial of Hormone Replacement for Post-Menopausal Women (7/10/2002)
Hormone replacement with estrogen plus progestin is often used to treat menopausal symptoms and to prevent osteoporosis and subsequent bone fractures. There has also been conflicting evidence that hormone replacement prevents heart disease. The association of hormone replacement with breast and uterine cancer has been well known, but usually these cancers present in early stages and do not affect survival. Estrogen and progestin are usually given together for women who have an intact uterus in order to prevent uterine cancer. Women who have had a hysterectomy usually are given estrogen alone. Researchers affiliated with the Women's Health Initiative have now reported that hormone replacement is not associated with prevention of heart disease, although overall survival was not affected one way or the other. Their results were published in the July 17 issue of the
Journal of the American Medical Association.
Virtual Colonoscopy Can be Used for Follow-up of Patients who have had Surgery or Radiation Therapy (5/15/2002)
Conventional colonoscopy sometimes fails to visualize the entire colon in patients who have a history of surgery and/or radiation therapy to the abdomen and/or pelvis. In addition, colonoscopy is not without risk and is an unpleasant experience for patients. Virtual colonoscopy, using similar methods to cleanse the bowel, is being explored as an alternative to colonoscopy. In this procedure, sophisticated computer programs simulate an actual colonoscopy.
Study Documents Effectiveness of Single Sigmoidoscopy at Age 60 in Detecting Cancer of the Colon (4/16/2002)
English investigators have reported in the April 13 issue of the
Lancet that flexible sigmoidoscopy screening regimen is acceptable, feasible, and safe. They found a high prevalence of cancer with a referral rate for colonoscopy of 5%.
New DNA Fecal Test Can Detect Colorectal Cancer (2/22/2002)
Several strategies for the early detection of colorectal cancers have been devised. Colonoscopy, sigmoidoscopy and barium enemas are highly specific and sensitive tests for cancer but they are invasive and limited by the availability of experts in the procedures and patient compliance. Virtual colonoscopy is an emerging approach to early diagnosis but is relatively untested. Evidence from some studies have shown that testing for occult blood in the stool may reduce incidence, morbidity and mortality from colorectal cancer. However, one limitation of testing for occult blood in the stool is that this test is not very specific.
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