Screening Rates Low for Colorectal CancerOne study shows half of patients return after having polyps removed< February 26, 2003 > Despite ample evidence that people who have had polyps removed from their colon are at a higher risk for a recurrence, this group is not getting screened as often as it should. In fact, only slightly more than half (52 percent) of people who had had polyps showed up for another screening in the follow-up period, says a recent report published in the Archives of Internal Medicine.
The article also verified that this group did have a higher recurrence of polyps, or small growths in the colon or rectum. "The single most important point of this article, from my standpoint, is that it confirms that surveillance following a colonoscopy is important because there's a high likelihood of recurrent polyps," says Dr. Michael Spencer, associate clinical professor of surgery at the University of Minnesota in Minneapolis and a member of the American Society of Colon and Rectal Surgeons. Colorectal cancers are the third most common cancers that occur in men and women, following skin cancer, says the American Cancer Society. Virtually all cancers come from polyps, a fact that makes early detection and removal especially crucial. According to the study authors, 37 percent to 60 percent of patients who have had a polypectomy (removal of polyps) are found to have more polyps at a later date. New screening guidelines recently issued by the US Multisociety Task Force on Colorectal Cancer recommend that individuals who have had one or two small polyps removed have their first follow-up colonoscopy at five years. Patients with at least three of the growths should get their first follow-up colonoscopy at three years. In this study, researchers looked at 8,865 patients who belonged to the same large health maintenance organization (HMO) in the Midwest that offered colorectal cancer screening as one of its benefits. All of the participants were at least 50 years old and had undergone a polypectomy between Jan. 1, 1989, and Dec. 31, 1999. Participants were followed up through Sept. 1, 2001. Of the total initial sample, 2,704 patients (or 30.5 percent) were diagnosed with recurrent polyps, a number not dramatically different from previous accounts. Estimates suggest that about half the participants will have a recurrence within 7.6 years. Among those who had a colonoscopy at least nine months after removal of polyps, 50 percent will probably have a recurrence within 3.9 years. There were no major differences in the results by gender, race, or age. The results were also akin to those found in other studies. "We're finding results that are similar, but these are updated," says Marianne Yood, an epidemiologist and lead author of the study. "That's not the huge shocker." The real shocker was that only 52 percent of the patients turned up for follow-up screening after their first procedure. "Half of the patients did not come back," Yood remarks. "One of the study restrictions was that patients had to be enrolled for at least one year after the polypectomy, 28 percent were enrolled more than five years, 13 percent more than seven years. I figure that they should all have come back at least once a year afterwards." "Obviously, physicians, the healthcare community, and others are not doing a good job in relaying the importance to the American public of screening for this disease," Spencer says. "These are people who should understand better than most the importance." Yood feels that the study indicates a need for other preventive measures. "Screening is really, really important, but I personally would like to see a focus on pharmaceutical interventions," she says. There is evidence that NSAIDs (nonsteroidal anti-inflammatory drugs, used for conditions such as arthritis) may decrease the risk for colon cancer. "There may be a role for putting that into some of the guidelines," says Yood. "I really believe that there's a lot of literature out there on NSAIDs, and I don't think it's incorporated into clinical practice." For now, screening, particularly in the form of a colonoscopy, will help prevent colorectal cancers. Perhaps introducing some uniformity among healthcare plans will help in the effort to increase screening rates. "Somehow screening and risk assessment procedures need to have universal applications throughout health plans," Spencer says. "Why can't we just have a health screening card that has our general information, evaluations, risk factors? It's a simple thing that you could do and swipe in at any hospital." Always consult your physician for more information.
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For more information on colorectal cancer, please visit the Digestive Disorders information module on this Web site. Red Meat and Fatty Foods Spell Trouble for Your ColonDiet heavy in red meat, fatty foods, and refined grains may increase colon cancer risk for women Women who eat a lot of red meat, fats, and refined grains could be increasing their risk of colon cancer. A new study, led by the Harvard School of Public Health, examined the associations between dietary patterns and colorectal cancer risk in women. The researchers examined dietary information from 76,402 women, aged 38 to 63 years old, who had no history of cancer in 1984. The information about the women, who were part of the Nurses' Health Study, was collected in 1984, 1986, 1990, and 1994. The researchers identified two major dietary patterns in the women—prudent and Western. The prudent eaters ate more fruit, vegetables, legumes, fish, poultry, and whole grains. The Western eaters ate more processed and red meats, sweets and desserts, french fries, and refined grains. During 12 years of follow-up on the women, the researchers identified 445 cases of colon cancer and 101 cases of rectal cancer. The study, published in a recent issue of the Archives of Internal Medicine, found a much greater colon cancer risk for women ranked in the highest category of Western dietary pattern. The study found no association between diet and rectal cancer. Always consult your physician for more information.
Colon Cancer ScreeningGet tested earlier if there is a family history of the disease Colorectal cancer—or cancer that begins in either the colon or the rectum—is the second-leading cancer killer in the United States.
The good news is that the disease is almost entirely preventable.
Prevention of Colorectal CancerAlthough the exact cause of colorectal cancer is not known, it is possible to prevent many colon cancers with the following:
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