A Family Affair: Understanding Colorectal Cancer Risk Factors and Screening Options Sioux Falls, South Dakota October 3, 2017 Durado Brooks, MD, MPH Vice-President, Cancer Control Intervention
What is Cancer? � � Cells are the basic building blocks of the body. � Cancer is the general name for a group of more than 100 diseases. � Cancer cells occur when cells grow in an out of control manner. Cancer Cells � Cell Mutates Cells Grow �
Colon and Rectum � � The colon (large bowel or large intestine) � is a muscular tube � about 5 feet long � � absorbs water and salt from food � stores waste matter � The rectum is the last 6 inches of the digestive system.
What is Colorectal Cancer? � � Colorectal cancer occurs when cells in the colon or rectum start to grow in an uncontrolled way � Often called simply “colon cancer” or “CRC”
How Common is CRC? � � 135,430 new cases expected in US in 2017 � 2 nd most common cancer when men and women are combined � 50,260 US deaths � 2 nd leading cause of cancer deaths; only lung cancer kills more Americans � 1.2 million Americans living with CRC � Incidence and death rates have fallen steadily past 30 years Cancer Facts and Figures 2017
Overall CRC death rate decline in the US �
Who Can Get Colorectal Cancer? � Anyone. Men and women of all ages and all races get CRC � – however risk is higher in African Americans and American Indian/Alaska Natives than other US populations
What Increases the Risk of Getting CRC? � � Family History � Cancer or polyps � Especially if diagnosed before age 60 � Age � 90% of colorectal cancers are found in men and women age 50 and older
What Increases the Risk of Getting CRC? � Modifiable risk factors � � Lack of physical activity � Less active � raises risk � Overweight � Obesity � raises risk of having and of dying from CRC � Smoking � raises risk � Alcohol use � raises risk � Red and processed meat � raises � risk �
Polyps and CRC � � Polyps are not cancer – but if left in place can grow and transform into cancer � 9 out of 10 cases start with a polyp � Many cases of CRC can be prevented by finding and removing polyps.
Cancer Screening � � Screening tests are done for people who don’t have symptoms (“asymptomatic”). They are part of routine health care – like checking your blood pressure. They should be done at regular intervals. � CRC Screening Tests look for early cancer or pre-cancers (polyps) of the colon and/or rectum.
Why is Screening Important? � People can’t feel abnormal growths (polyps or early cancer) growing inside of them. The only way to find them is by getting screened.
Why is Screening Important? � Screening � finding cancer early � improved survival � Survival Rates by Disease Stage* 90.3% 100 90 70.4% 80 70 60 5-yr 50 Survival 40 30 12.5% 20 10 0 Local Regional Distant Stage of Detection
Why is Screening Important? � There are 2 goals for CRC screening: � 2. Early Detection 1. Prevention Find cancer in the early stages, Find and remove polyps when best chance for a cure to prevent cancer
CRC Screening Tests � Options for Average risk adults age 50 and older: Direct Visualization Tests Colonoscopy every 10 years, or Flexible sigmoidoscopy (FSIG) every 5 years, or Double contrast barium enema (DCBE) every 5 years, or CT colonography (CTC) every 5 years Stool Based Tests G uaiac-based fecal occult blood test (gFOBT) with high test sensitivity for cancer, or Fecal immunochemical test (FIT) with high test sensitivity for cancer, or Stool DNA test (sDNA), with high sensitivity for cancer
Most Commonly Used Screening Tests � � Colonoscopy � Stool Testing
Colonoscopy � • Long lighted tube with camera • Views entire inside of colon • If normal, no other testing needed for 10 yrs • Covered by Medicare and most insurance – often with no co-pay
Colonoscopy � � If polyps are found during a colonoscopy they can be removed with tools used through the narrow scope. � Removing polyps before they turn into cancer is how tests like this can prevent cancer.
Other Things to Know About Colonoscopy � � Colonoscopy misses some polyps and � cancers � � Very safe overall, but complications can � occur (bleeding, perforation, stroke, heart � attack,…) � � Doctors have different skill levels at finding � and removing polyps � � Many patients don’t like the colon cleansing required before the test (the “prep”) � Can be expensive if not covered by insurance �
Types of Stool Tests* � A) Tests that look for hidden blood � Fecal Immunochemical Test (“FIT”) B) Tests that look for hidden blood AND for abnormal DNA � � One test (Cologuard) available in U.S. * Stool tests are only appropriate for average risk patients �
Fecal Immunochemical Tests (FIT) � � Looks for microscopic amounts of blood in the stool � Patient gets a kit with instructions from their doctor's office or clinic � Complete the kit at home � Return the kit to the doctor's office or medical lab for testing � If test is abnormal – MUST have colonoscopy
Fecal Immunochemical Test (FIT) � � Finds approximately 7 of 10 cancers. � Recommended for CRC screening in guidelines from major organizations. � If test results are normal it should be repeated every year. � Patients with abnormal FIT results MUST have a colonoscopy. � If FIT is chosen as the initial screening test, and results are abnormal, the patient may have a co-pay for the needed colonoscopy.
Stool Test for Abnormal DNA � � Cancer and polyps bleed only sometimes – so FIT will only find them sometimes. � Colon cells are shed into � the stool continuously. � � Polyps and cancer cells contain genetic material (DNA). � Stool DNA tests look for abnormal DNA from cells that are passed in the stool.
Cologuard (FIT + DNA) � � One test (Cologuard) � currently available. � � Combines stool test for blood plus stool test for abnormal DNA. � In one large study Cologuard detected more than 9 of 10 cancers. � Recommended for CRC screening in guidelines from major organizations.
Cologuard (FIT + DNA) � � If test results are normal Cologuard should be repeated once every 3 years. � Patient with abnormal Cologuard result MUST have colonoscopy � Covered by Medicare and some private insurers � If Cologuard is chosen as the initial screening test, and results are abnormal, the patient may have a co-pay for the needed colonoscopy.
How Can You Lower Your Risk? � � Get screened for colorectal cancer � Early cancer has no symptoms – so don’t wait! � � Discuss your personal and family history with your doctor � Maintain a healthy weight throughout life � Eat a healthy diet � Emphasis on fruits, vegetables and whole grains � Limit processed and red meats
How Can You Lower Your Risk? � � Be more physically active (walking, biking, gardening,…) � Limit alcohol consumption � Notify your doctor if you have signs and symptoms � Blood in stool � Change in bowel habits � Abdominal pain � Weight loss
Patient Education � Get Tested For Colon Cancer: Here's How." An 7-minute video reviewing options for colorectal cancer screening tests, including test preparation. Available as DVD, or you can refer patients to the URL to view from their personal computer. This image canno t currently be display ed. https://www.cancer.org/cancer/colon-rectal-cancer/colon-cancer-videos.html
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