There is a modest reduction in colon polyps (adenomas) in those eating the most servings of fruit and vegetables in the year before a colonoscopy. 

Among participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 3,000 people with at least one colon polyp were compared to 29,500 controls.  Food frequency questionnaires were analyzed for fruit, vegetables, onions, and garlic.

Fewer polyps were limited to the colon, not the rectum.

There was a 25 percent reduction in polyps among those who ate the most fruit (5.7 servings a day compared to 1.2 servings.)  Servings were based on the food pyramid.  This difference didn’t appear to be related to either dietary folate or fiber.

However, total vegetable intake was not related to fewer adenomas.  There was a decrease in adenomas in those eating the most daily servings of deep-yellow vegetables, onions, and garlic.  The trend for deep-green vegetables was not significant.

Amy Millan and her colleagues concluded,

Diets rich in fruit and deep-yellow vegetables, dark-green vegetables, and onions and garlic are modestly associated with reduced risk of colorectal adenoma, a precursor of colorectal cancer.

SOURCE:  Millan et al, American Journal of Clinical Nutrition, Volume 86, Number 6, December 2007.

Fewer blacks than whites receive recommended cancer treatment including chemotherapy after surgery for both colon and rectal cancers.  And, there has been little improvement in differences over the past ten years.

Blacks were 27 percent less likely to have chemotherapy to reduce the risk that rectal cancer might return after surgery and 24 percent less likely to have chemo after surgery for colon cancer that had spread to lymph nodes.

Only half (52 percent) of blacks had recommended chemotherapy for stage III colon cancer while two-thirds (64 percent) of whites received the treatment that reduces the risk that cancer will return and improves survival.

Researchers at Yale University School of Medicine analyzed the SEER-Medicare database for143,000 Medicare-insured patients treated for lung, breast, colon, rectal, or prostate cancer between 1992 and 2002. They looked specifically at seven recommended treatments to see if there was a difference between blacks and whites in actually receiving care.

Besides less effective treatment for colon and rectal cancer, blacks were less likely to have early lung cancers removed, get surgery or radiation for prostate cancer, or have radiation follow-up for breast cancer.

Cary Gross MD, who headed the study team, wrote,

There has been little improvement in either the overall proportion of Medicare beneficiaries receiving cancer therapies or the magnitude of racial disparity. Efforts in the last decade to mitigate cancer therapy disparities appear to have been unsuccessful.

SOURCE:  Gross et al, Cancer, published early online January 7, 2008.

Reuters Health has an expanded article about the study written by Will Durham.

Most patients who are treated for stage II colon or rectal cancer will do well, surviving for at least five years.  However, about 20 percent will not.  It hasn’t been clear whether or not chemotherapy makes a difference in survival, but a recently analyzed large study finds that it does, although the benefit is small.

The QUASAR (Quick and Simple and Reliable) clinical trial randomized more than 3,200 patients with colon or rectal cancer to receive chemotherapy or simply be observed.  Most of the patients — 91 percent — had stage II cancer where cancer cells had not yet spread to nearby lymph nodes.  Seven in ten had colon rather than rectal cancer.

Patients were treated from 1994 through 2003 in 150 centers in 19 countries.

Trial chemotherapy was 5FU (fluorouracil) modified by leucovorin (folinic acid).  Chemo was given either every week for thirty weeks or for five days in a row every four weeks for six treatments.  Since the trial began, more effective treatments using oxaliplatin, continuous infusion 5FU, or Xeloda have been found and are now in use.

After a median follow-up of 5.5 years, there were 311 deaths from any cause in the chemotherapy group and 370 in the observation-only group (relative risk 0.82) and 293 recurrences in the chemo group compared to 359 in the observation group (relative risk 0.78).  That translates to about a 3.6 percent absolute reduction in the risk of dying when chemotherapy is used — or about 4 more people in every 100 treated alive after 5 years.

Treatment effectiveness did not differ significantly by where the tumor was located, the age or sex of the patients, or which chemo regimen was used.

Interpreting the study, the QUASAR Collaborative Group headed by Dr. Robert Gray wrote,

Chemotherapy with fluorouracil and folinic acid could improve survival of patients with stage II colorectal cancer, although the absolute improvements are small: assuming 5-year mortality without chemotherapy is 20%, the relative risk of death seen here translates into an absolute improvement in survival of 3·6%.

The Group was also encouraged that,

Chemotherapy seems to prevent a proportion of recurrences and deaths, rather than just delaying them, which makes the life-years gained more substantial, especially for younger patients.

SOURCE: Gray et al, The Lancet, Number 370, Issue 9604, December 15, 2007.

More information on the study from Reuters Health , Medical News Today, and Medscape.

Thousands of Americans may carry a single genetic change that puts them at high risk to develop colon cancer.  Using genealogy information from two families, one in Utah and one in upstate New York with the identical genetic change, researchers traced both families back to a husband and wife who sailed to America from England in the early seventeenth century.

The mutation causes attentuated familial adenomatous polyposis (AFAP) and is responsible for a risk of increased numbers of colon polyps (adenomas) and eventually colon or rectal cancer.  The research team estimates that lifetime colorectal cancer risk for an individual carrying the identified mutation is about 69%.

Researchers are concerned that the genetic risk for polyps and colon cancer may extend to many more people in the United States and not be recognized.   The same mutation has been identified in other AFAP families who also share a genetic fingerprint called a haplotype that identifies individuals with common ancestors.

The Family

The couple was married in St. Nicholas, Somerset, England in 1615.  A son born in 1615 is an ancestor of the New York family, and a daughter born in 1620 has descendents in the Utah family.  Records show a daughter was married in Weymouth, Massachusetts in 1640.

Since the specific change has not been found in European families, it is assumed that either the husband or wife in the immigrant family was the first person to have the mutated gene and passed it along to his or her children and some of their descendents. 

The Utah family or kindred (kindred #353) has been traced to a founding set of parents born in New York and Massachusetts in the 1790′s who moved to Utah as part of the Mormon immigration in 1850.  More than 7000 individuals from this family are included in the Utah Population Database, which is linked to birth and death certificates in Utah and cancer registries in Utah and Idaho.  The family history spans 9 generations.

The New York kindred (#439) includes 6 generations since the founding parents were born in 1830.

The current study included 490 members of the Utah family where 145 were mutation positive and 99 members of the New York family with 36 positive members.  Information about the study group revealed:

• Average age for developing colon cancer was 58.
• The median number of polyps (adenomas)  was 25
• One-third (36.6 percent) had fewer than 10 polyps
• Thirteen percent had no family members with more than 10 polyps
• Number of polyps didn’t appear to affect risk for developing colon cancer.

Mutations in APC gene

A variety of mutations in the tumor suppressor APC (adenomatosis polyposis coli) gene lead to both familial adenomatous polyposis (FAP) and attenuated adenomatous polyposis.  FAP patients have hundreds of polyps lining their intestinal tracts often beginning in the teenage years.  Lifetime risk of colorectal cancer, if there is no intervention, is 100 percent.

Patients with attenuated familial adenomatous polyposis or AFAP have fewer polyps (less than 100), tend to get them at when they are older, and usually have them in the upper part of the colon rather than throughout it.  Lifetime risk of colon or rectal cancer is lower.  For this particular mutation it is about 70 percent.

Genetic testing to identify risk

Because patients with fewer than ten polyps or who are diagnosed over age 50 may appear to be very much like people with sporadic colon cancer, it is challenging to identify mutation carriers, according to Deborah W. Neklason and the study authors at Huntsman Cancer Institute at the University of Iowa.

They suggest that the combination of young age at diagnosis and family history of colon polyps may identify individuals who carry an AFAP mutation.  Specifically, they write,

A family history of colonic polyps or cancer in combination with any number of adenomatous polyps at a young age may be the key to recognizing potential AFAP patients from the vast number of individuals with sporadic adenomas. We suggest that genetic testing should be considered in any individual with a family history of 10 or more colonic adenomas based on the observation that 86.7% of mutation-positive individuals in this family would be captured with this criterion.

SOURCE: Necklason et al. Clinical Gastroenterology and Hepatology, Volume 6, Number 1, January, 2008.

An article about the study by Michael Kahn appears in Reuter’s Health.

Barack Obama and Mike Huckabee won over the hearts of the Iowa Caucus on Thursday night.

The Democrat from Illinois and the Republican from Arkansas surprised a lot of people when they came out on top to take the victory in Iowa, and become the leading candidates of their respective parties.

I know everyone may feel this year’s presidential race has been an ongoing soap opera that has lasted too long…well the party has just started.

The candidates now make their way to New Hampshire where John Edwards, Hilary Clinton, Mitt Romney and Rudy Giuliani vow to redeem themselves.

Stay tuned…