In a recent study, women with Type 2 diabetes had almost twice the risk of having a potentially pre-cancerous polyp (adenoma) discovered during colonoscopy than women without diabetes.  They had an even greater risk of having an advanced adenoma.  Obesity increased risk for both diabetics and non-diabetics, but diabetics who were also overweight had the greatest chance that an adenoma would be found.

Forty-two percent (42%) of obese diabetics had an adenoma diagnosed during colonoscopy.  Nineteen percent (19%) had an advanced adenoma. An advanced adenoma was larger than 1 cm or one that had early signs of cancerous changes including dysplasia or villous or tubulovillous features.

100 diabetic women, undergoing screening colonoscopy were matched to 500 controls without diabetes. There were 245 women  studied who met criteria for obesity (high body mass index or BMI). Study results showed:

• Diabetic women had a 37% risk of any adenoma compared to 24% of non-diabetics.
• Diabetics had a 14% risk of an advanced adenoma compared to 6% of non-diabetics.
• Obese women had a 32% risk of any adenoma compared to 22% of women who were not obese.
• Obese diabetics risk for any adenoma was 42% and 19% for advanced adenoma compared to 23% for any adenoma and 7% for advanced adenoma in women who were neither diabetic or obese.

Digestive Disease Week 2006:  JE Elwing et.al. Type 2 Diabetes Mellitus: The Impact on Colorectal Adenoma Risk in Women

Jill E.Ewing of Washington University, the lead study author warned:

“Colorectal cancer screening is critical for this population, as their diabetic condition raises their risk of colorectal cancer.”

The study, along with other research from Digestive Disease Week 2006 that looks at factors that increase risk for gastrointestinal cancers, is reported on Medical News Today.

Type 2 diabetes colorectal adenomas colon cancer risk

Anne Brady Moore lost her mom to colorectal cancer and her dad to bladder cancer.  Read how one woman is making a difference in her community.

We need more people like Anne Brady spreading the word that colorectal cancer is preventable, beatable and treatable. Find out what you can do to make a difference in your community.

After a 60 day break to review safety concerns, the international AVANT Phase III clinical trial of Avastin™ (bevacizumab) for early stage colon cancer will begin recruiting patients again.  An independent Data Safety Monitoring Board (DSMB) has concluded that there is no imbalance in cardiac complications among the three arms of the study and has cleared the trial to resume.

The clinical trial was suspended in February when there were concerns about an unusual number of deaths in one arm of the trial.  In addition, rapid trial enrollment left the DSMB unable to review all study data in a timely way.

Genentech, manufacturers of Avastin™, announced on May 23, 2006 that their international partner Roche had decided to resume the trial based on DSMB recommendations.  Patients recruitment will begin again after clearance by European health authorities and local Independent Review Boards.

The Data Monitoring Safety Board found no significant differences in cardiac problems.  They also concluded that

“…the current safety profile and overall mortality observed in AVANT are consistent with those seen in other early-stage colon cancer trials.”

However, trial procedures have been changed to include additional cardiac testing before patients begin treatment and cardiac monitoring during treatment.

The AVANT trial is studying treatment for stage II and III colon cancer patients after surgery to remove their tumors.  Its arms include:

• FOLFOX (oxaliplatin, leucovorin, and continuous infusion 5FU) alone.
• FOLFOX plus Avastin™
• XELOX (oxaliplatin and capecitabine) plus Avastin™

A similar randomized Phase III trial in the United States continued to enroll patients without unusual safety problems arising.  NSABP C-08 compares FOLFOX alone to FOLFOX plus bevacizumab. It does not have a capecitabine arm.

Both trials are accruing patients rapidly. More than two-thirds of the AVANT goal of 3,450 patients has been met, and 2,000 of 2,700 potential C-08 patients are already enrolled.

In announcing the trial resumption, Hal Barron, M.D., chief medical officer for Genentech, said,

“Following rapid patient enrollment into the AVANT study, we believe the temporary halt of recruitment to assess safety was the right thing to do for patients. The U.S.-based adjuvant trial, NSABP C-08, has continued to enroll as planned with no changes to its protocol. The AVANT and NSABP C-08 trials, which have different treatment arms, provide an opportunity to investigate whether adding Avastin to standard chemotherapy as adjuvant therapy may be safe and effective in patients with early-stage colon cancer.”

Avastin bevacizumab AVANT trial NSABP C-08

While excessive drinking has been previously tied to an increased risk for colorectal cancer, in a new study moderate drinking — 2 to 6 drinks a week — reduced the risk of having an adenoma (pre-cancerous polyp) over those people who did not drink at all.  However, people in the study who consumed more than 14 alcoholic drinks in a week had almost two and a half times the risk of polyps as the moderate drinkers.

Researchers at the University of North Carolina led by Gregory Austin M.D.divided study participants into 5 groups based on the average number of alcoholic drinks they had each week.  All had a colonoscopy. Those who did not drink were about 41% more likely to have an adenomatous polyp found during the colonoscopy than the moderate drinkers.  Heavy drinkers had more than 2.5 times the odds of having a polyp.

The research team adjusted their statistics for other known polyp risks including sex, age, body mass index, race, and smoking.

They concluded:

Individuals who consume moderate amounts of alcohol are at lower risk of colorectal adenomas than nondrinkers and heavy drinkers. Moderate alcohol consumption may benefit the colon as well as the heart.

The study was reported during the 2006 Digestive Diseases Week meeting in Los Angeles.

adenoma risk alcohol consumption

An improved fecal DNA screening test can uncover 88% of colorectal cancers.  The new test improves the way stool is treated for shipping , the technique for analyzing it, and the biomarker panel studied.

After a colonoscopy identified 122 people with normal colons — no polyps or cancers — and 40 with colorectal cancer, both groups prepared and shipped one stool sample to the laboratory at EXACT Sciences, the developer of the  fecal DNA test.  Before shipping via Express Mail, patients added a buffer to the specimen to reduce changes in DNA that can occur even in short time before analysis.

At the lab, DNA shed into the stools was removed using a new gel technique.  In addition to the previous genetic marker panel, changes in an additional gene (vimentin) were analyzed.  Studies have shown that vimentin changes are found in about 46% of people with colorectal cancer compared to 10% of those who have normal colon linings.

The complete test identified colorectal cancer in 87.5% of those who already had cancer (sensitivity).  There were false positive readings in 18% of normal participants (specificity of 82%.)  This compares to 52% sensitivity and 94% specificity in a multicenter trial of a previous version of the fecal DNA test (PreGenPlus Version 1.)

The test was more specific for advanced colorectal cancer.  It found 75% of stage I cancers, 90% of stage II, 93% of stage III, and 100% of stage IV cancers, those that had spread beyond the colon.

Research results were presented at the 2006 Digestive Disease Week conference being held May19–24, 2006 in Los Angeles.  Additional information is available on the EXACT Sciences web site.

An article about the new test appears on cancerfacts.com.

fecal DNA test