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Colorectal Cancer #2 Cancer Killer SCREENING SAVES LIVES 1 The Bad News: Frequency Average risk - 1 out of 18 chance per lifetime High risk – 1 out of 5 chance per lifetime 2 The Bad News: Deadly 1. Lung Cancer 2. Colorectal Cancer 3 The Bad News: Expensive 4 Risk for colorectal cancer Average Risk 1 in 18 chance High Risk 1 in 5 chance 5 Assessing your individual risk You have more than average risk if you have any of the following risk factors: • • • • Personal history of colorectal cancer or polyps Personal history of inflammatory bowel disease Family history of colorectal cancer or polyps Certain inherited cancer syndromes Even without symptoms, people with these risk factors need earlier and more frequent screening 6 Assessing your individual risk Also, you have more than average risk if you have one or more of the following symptoms: – – – – Rectal bleeding Iron deficiency anemia Change in bowel habits; constipation or diarrhea Persistent abdominal pain If you have these symptoms, you should seek evaluation immediately. 7 AVERAGE RISK IF YOU DON’T HAVE THESE RISK FACTORS OR SYMPTOMS YOU ARE CONSIDERED TO HAVE AVERAGE RISK FOR DEVELOPING COLORECTAL CANCER 8 IMPORTANCE OF AGE 50 Colorectal Cancer Occurrence for Average Risk Individuals 7% Before Age 50 After Age 50 93% 9 LISTEN UP AVERAGE RISK IOWANS High-Risk Cases: 25% 75Average-Risk Cases: 75%% 10 American Cancer Society. Cancer Facts & Figures 2002. Atlanta, GA: American Cancer Society; 2002:20–27. Good News A series of changes in the cells lining the colon takes 10 years to progress from normal to colon cancer. 10 10 years Normal Polyp There is time to intervene Cancer 11 More Good News Alive 5 years later Alive at diagnosis 1 year 2 year 3 year 4 year 5 year • The most preventable form of digestive tract cancer if screening is performed 12 And More Good News: FOBT Colonoscopy Flex Sig Double Contrast Barium Enema 13 So What’s the Problem? 14 Late Detection Five year survival rates 100 95% 80% 100 75 75 50 50 25 25 0 Stage I Stage II (Dukes’ A) (Dukes’ B) Only 37% of patients are diagnosed early 55% 10% 0 Stage III Stage IV (Dukes’ C) (Dukes’ D) 63% of patients are diagnosed late American Cancer Society. Cancer Facts & Figures 2002. Atlanta, GA: American15 Cancer Society; 2002. Why aren’t Iowans screened? • The most common reasons • A screening test was never recommended • Misunderstanding, fear and embarrassment • Cost • Assuming that absence of risk factors or symptoms means that there is no cancer 16 How do you screen for colorectal cancer? Beginning at age 50: Fecal occult blood test (FOBT) every year or Flexible sigmoidoscopy (FS) every 5 years, or FOBT annually + FS every 5 years or Colonoscopy every 10 yrs or Double -contrast barium enema every 5 yrs. 17 Fecal Occult Blood Test (FOBT) 18 Flexible Sigmoidoscopy 19 Location of polyps/cancer Right side Left side 10% 30% 15% 25% 20% 20 FOBT AND FS • FOBT detects larger, bleeding polyps, but is less accurate for smaller, non-bleeding polyps • Flexible sigmoidoscopy detects left-sided lesions, but misses 30-40% of all polyps and cancers that are right-sided • The combination of both tests largely corrects the limitations of performing either test alone. FS + FOBT=75% 21 Colonoscopy examines entire colon removes polyps biopsies cancer 22 Double Contrast Barium Enema (DCBE) 23 Other New Screening Tests • Virtual colonoscopy • Stool DNA test 24 Virtual Colonoscopy 25 Stool DNA Test Physician Sends Requisition to Lab Patient Collects Stool at Home Lab Provides Collection and Shipping Materials to Patient Stool DNA Analysis Is Performed in Lab Physician Patient Returns Specimen to Lab Physician Communicates Results to Patient DNA Alteration Identified: Perform colonoscopy No DNA Alteration Identified Continue screening 26 What Should You Consider in Choosing a Screening Test • • • • What does my doctor recommend? Which test is most accurate? Which test is most convenient? Which causes the least discomfort, fear embarrassment? • Cost-insurance, Medicare coverage? • What do other people say about it? 27 Test cost Screening Test FOBT FS DCBE Colonoscopy Estimated Charge $10-30 $150-300 $250-500 $600-1500 28 Medicare Coverage for Average Risk patients Blood stool test (FOBT) annually Sigmoidoscopy every 4 years Colonoscopy every 10 years Double contrast barium enema as an alternative to either sigmoidoscopy or colonoscopy every 5 yrs (since July 1, 2001) 29 The Cost of NOT screening – Individual early disability and death – Emotional costs for patients and family – Treatment cost of colon cancer care 30 So What? • An average risk adult has a 1 in 18 chance of developing this cancer. • A high risk adult has a 1 in 5 chance of developing this cancer. Can you afford to take this chance? 31 You Can Reduce Deaths Due to Colon Cancer Screening! Screening! Any method of screening is preferable to not screening! 32 Have You and Your Loved Ones Been Screened? #2 Cancer Killer 33 This presentation was developed by the Iowa Colorectal Cancer Task Force 34 Acknowledgements • American Cancer Society • Centers for Disease Control and Prevention • Exact Sciences • Dr. John Bond, Univ. of Minnesota • Dr. Douglas Rex, Univ. of Indiana • Dr. Robert Summers, Univ. of Iowa 35 Colorectal Cancer Web Links www.cancer.org www.ccalliance.org www.preventcancer.org/colorectal www.hopkinskimmelcancercenter.org www.colorectal-cancer.net www.cdc.gov/cancer/screenforlife/index.htm 36