You can do a lot to prevent colon and rectal cancer this year . . . and in the future.

Number One Resolution — Be screened for colorectal cancer if you are 50 or over, earlier if you are at higher risk.

In addition you can reduce your  colorectal cancer risk by:

• Exercising regularly.
• Keeping your weight normal.
• Eating less red meat, no processed meat at all, and mostly plant-based foods.
• Increasing the amount of fiber in your food.

Start on Monday, January 2, and review your progress toward better diet and exercise every Monday all year.  Research from leading public health schools for The Monday Campaigns shows that most people view Monday as a day for fresh starts.  They were most likely to begin exercising, start a diet, or stop smoking on Monday.

For the latest evidence on food, nutrition, and physical activity and their influence on colorectal cancer, read the World Cancer Research Fund’s Continuous Update Project focus on colorectal cancer.

Happy, healthy New Year!

Summer’s over. The black squirrels in the front yard are scurrying around hunting acorns and my inbox is full of neat nuggets of colorectal cancer news — and I don’t want to leave them buried all winter.

So here they are in brief.  You can check the links for more details.

Mixed Results Using Acupuncture for Radiation Nausea

The good news is that almost all patients felt they had less nausea after either real or sham acupuncture to manage nausea and vomiting during radiation therapy.  Nine out of ten wanted more treatments.

The sham procedure used non-penetrating needles just pressed against the skin, but neither the patients who got real acupuncture or those who got sham treatments knew which they received.

Ninety-five percent in the real acupuncture group and 96 percent in the sham acupuncture group believed that the treatment had been effective against nausea.  However, 70 percent of the real group and 62 percent of the sham group did experience nausea — for an average of 10 days for real treatments and 9 days for sham.

In addition, 25 percent of the real group and 28 percent of the sham group vomited.

So measured objectively, there was still significant nausea and whether or not acupuncture was “real” or just pretend, it made no measurable difference.

Dr. Anna Enblom from the Karolinska Institute in Stockholm said,

The beneficial effects seem not to come from the traditional acupuncture method, but probably from the patients’ positive expectations and the extra care that the treatment entails.

Read more in articles by Dr. Enblom and her colleagues in Annals of Oncology and earlier this year in PLoS ONE where acupuncture, both real and sham was compared to standard nausea care.  Dr. Enblom also was featured in a news release from the Karolinska Institute.

Why Research on Fruits and Veggies and Colorectal Cancer Risk is Confusing

More fruits?  More veggies? Less colon cancer? Less rectal cancer?

Doesn’t make a difference.  Makes a big difference.

Are you confused when you read media stories based on new research about the impact of diet on colon and rectal cancer?

It may be that different fruits and vegetables have different effects depending on where cancer develops — in the proximal colon (near the top), the distal colon (near the rectum), or the rectum itself.

The research team from the Western Australian Bowel Health Study compared fruit and vegetable intact between people who had been diagnosed with colon or rectal cancer and a similar group of cancer-free individuals. They specifically looked at where the cancer was in the colorectal tract.

While total intake of fruits and vegetables and total intake of vegetables did reduce distal cancer, neither had any impact on proximal or rectal cancer. Brassica vegetables like broccoli and cabbage reduced proximal colon cancer risk, while risk for distal cancer was significantly reduced by eating dark yellow vegetables and apples.

Rectal cancer risk was increased by drinking fruit juice.

The discovery of differences should impact future diet studies for reducing colorectal cancer risk. Epidemiologist and study author Professor Lin Fritschi, PhD explained.

Fruits and vegetables have been examined extensively in nutritional research in relation to CRC, however, their protective effect has been subject to debate, possibly because of different effects on different subsites of the large bowel.

It may be that some of the confusion about the relationship between diet and cancer risk is due to the fact that previous studies did not take site of the CRC into account. The replication of these findings in large prospective studies may help determine whether a higher intake of vegetables is a means for reducing the risk of distal CRC.

The study was reported in the October Journal of the American Dietetic Association.

The bottom line for people who want to reduce their risk of colon and rectal cancer is that eating fruit and vegetables does help prevent cancer in some parts of the colon and rectum, but doesn’t guarantee that cancer won’t occur.  Getting fruit from juice may not be the best choice because that does increase rectal cancer risk.

Even a Little More Exercise Helps

Although recommendations are for 150 minutes of exercise a week or 30 minutes a day to reduce risk of dying from cardiovascular disease or cancer, even less activity can increase life expectancy.

Following over 415,000 people in Taiwan over an average of 9 years, researchers found that even 15 minutes a day (92 minutes a week) of physical activity increased life expectancy three years compared to those people who had no exercise at all. The no exercise group had a 17% increased risk of dying compared to the low-exercise group.

After an initial 15 minutes every day (low-volume exercise) every additional 15 minutes of daily exercise decreased risk of dying from any cause by 4% and dying from cancer by1%.

Dr Chi Pang Wen MD from the National Health Research Institutes in Zhunan, Taiwan reported study results in the October 1, 2011 issue of The Lancet.

In order for tumor screening to be cost-effective, not only should new tumors be tested, but family members need to follow through with genetic testing after a new Lynch mutation is found.  Finally people with Lynch syndrome mutations need to follow surveillance guidelines to prevent cancer or find it early,

Testing both tumors and at least three to four family members could cost as little of $36,000 per life year saved — well within the value of preventive health strategies.

Researchers used a computer model to predict costs of  testing tumors using several strategies, upper age limits, and assumptions about family members following up with genetic testing.

In order to fall beneath the $50,000 per life year saved threshold for cost-effectiveness, three to four family members needed to follow up with DNA testing for an identified Lynch syndrome mutation.

Women with Lynch syndrome could improve their life expectancy by about four years if they had their uterus and ovaries removed and followed the colorectal cancer surveillance guidelines, the study found.

The researcher team said that the ideal testing strategy was for pathologists to:

1. Use immunohistochemistry (IHC) tumor tests to look for missing protein expression  related to Lynch syndrome (MLH1, MSH2,MSH6, PMS2).
2. If IHC is positive, followup with tumor tests for a BRAF V600E  mutation.  (Inherited Lynch mutations don’t have BRAF mutations.)
3. If IHC is positive and BRAF is negative, do DNA blood tests for an inherited germline Lynch syndrome mutation.

Once an individual is identified with an inherited Lynch syndrome mutation, it is critical to inform close family members — siblings, children, and parents — of their own potential risk.  Since Lynch syndrome is passed directly from parent to child (autosomal dominant), children of an affected parent have a 50-50 chance of inheriting the gene.

When they know they are at risk, family members should also have DNA testing.  However, they only need to be tested for the gene discovered in their family — a much less expensive process.  Genetic counseling after their test can help them understand what the test results mean and, if positive, what steps they can take to protect themselves against cancer.

Study leader, Uri Ladabaum, M.D., from Stanford University, said,

A systematic approach to identify families with Lynch syndrome makes sense clinically, because it can save lives, and economically, because its costs are comparable to other things we choose to spend our health-care dollars on, We advocate establishing similar tumor-screening systems on a national level.

The study team, led by Dr. Ladabaum, included members from Stanford, University of California, Baylor University, and Memorial Sloan Kettering Cancer Center.  They concluded,

Widespread colorectal tumor testing to identify families with the Lynch syndrome could yield substantial benefits at acceptable costs, particularly for women with a mutation associated with the Lynch syndrome who begin regular screening and have risk-reducing surgery. The cost-effectiveness of such testing depends on the participation rate among relatives at risk for the Lynch syndrome.

Although family history can help identify individuals and families that may carry a Lynch syndrome mutation, it is not foolproof.  About half of families with mutations don’t meet the criteria and another half who do have histories that meet Amsterdam criteria don’t have one of the identified Lynch mutations.

In an editorial accompanying the study report in Annals of Internal Medicine, Dr. Randall Burt  from the University of Utah and the Huntsman Cancer Center points out:

The Amsterdam criteria were developed to identify persons and families who are likely to have the syndrome. The criteria include the following: 3 relatives in a family must have colorectal cancer, and 2 of them must be first-degree relatives of the third; at least 2 generations must be affected; and 1 of the cases must be diagnosed at an age younger than 50 years (2). These criteria have been successfully used to identify families with the Lynch syndrome but have also proven to be insensitive. At least 50% of families with the condition do not meet the criteria. About one half of families meeting the criteria will have a disease-causing mutation in one of the mismatch repair genes ( MLH1, MSH2, MSH6, or PMS2).

The Annals of Internal Medicine includes a summary for patients that describes the study and what it means.

SOURCES:

Ladabaum et al., Annals of Internal Medicine, Volume 155, Number 2,  July 19, 2011.

Burt, Annals of Internal Medicine, Volume 155, Number 2,  July 19, 2011.

What This Means for Patients

This study looks at how costly a testing strategy to identify people with Lynch syndrome is for a large population.  The cost isn’t for one individual or one family, but for everyone in a national health care system.

However, it does support the idea that people who have surgery for colon or rectal cancer should have simple, inexpensive tests done on their tumor tissue to see if they might have Lynch syndrome.

This not a definitive test for Lynch syndrome.  It will also be positive for people who don’t have Lynch, but it will also screen and find those who do.

About 15 out of 100 of people with colon or rectal cancer will have tumors that suggest Lynch syndrome, but only 3 to 5 of them will actually carry a Lynch mutation.

Many of these people with Lynch mutations won’t have strong family cancer histories, so tumor testing is the only way the syndrome would be uncovered.

If you have had surgery to remove a colon or rectal tumor, check with  your doctor to see if testing for microsatellite instability (MSI) has been done.  It will be part of the pathology report from the surgical specimen.  Many hospitals are now doing this test automatically after surgery at the same time they look for lymph nodes and other tumor information.

If it wasn’t done, you might want to request it.  The tumor block saved by the pathology department should still be available for the test.

If testing does indicate you might carry a Lynch mutation, you’ll want to talk to a genetic counselor about DNA testing to either confirm or rule out Lynch syndrome.

The test can save your life by changing the way your cancer is followed up.  And it can save the lives of your brothers, sisters, and children if they also have the mutation.

That’s the recommendation of the World Cancer  Research Fund’s Continuous Update Project  for 2011.

Based on new evidence, the World Cancer Research Fund/American Institute for Cancer Research’s Continuous Update Project  (CUP) report also upgraded evidence for dietary fiber decreasing colorectal cancer risk from probable to convincing.

The CUP  found convincing evidence that physical activity reduces risk of getting colorectal cancer.  Research is also convincing that alcoholic drinks for men, fat carried around the waist,  and overall fatness increase risk.

Probably garlic, milk, and calcium supplements protect against colorectal cancer, while alcoholic drinks for women increase risk.

For colorectal cancer, the 2011 Continuous Update Project confirmed and expanded the WCRF/AICR’s 2007 Expert Report–  Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective.

In addition to the 749 studies reviewed by the panel in 2007, and additional 263 research results looking at colorectal cancer risk and diet, exercise, and weight were added to the 2011 update.

Dr. Elisa Bandera, who is a member of the WCRF/AICR CUP  said,

AICR has estimated that about 45 percent of colorectal cancer cases could be prevented if we all ate more fiber–rich plant foods and less meat, drank less alcohol, moved more and stayed lean. That’s over 64,000 cases in the US every year.

Dr. Bandara continued,

Many people feel confused about cancer prevention because it can seem like a new study is published every week that suggests something either causes or prevents cancer.

But the CUP takes the latest scientific findings and adds them to the existing body of evidence in a systematic way that ensures our advice takes the latest research into account. This means people can be confident that AICR’s recommendations represent the most up–to–date, evidence–based information on cancer prevention available.

In conclusion, the Panel judged,

• The evidence that physical activity protects against colon cancer is convincing. The evidence that consumption of foods containing dietary fibre protects against colorectal cancer is convincing. The evidence that red meat, processed meat, ethanol from alcoholic drinks (by men, and probably by women), as well as body fatness and abdominal fatness, and the factors that lead to greater adult attained height, or its consequences, are causes of colorectal cancer is convincing.
• Consumption of garlic, milk, and calcium, probably protect against this cancer.
• The evidence that non-starchy vegetables, fruits and foods containing vitamin D protect against colorectal cancer, and that foods containing iron, and also cheese, foods containing animal fats, and foods containing sugars are causes of this cancer is limited. Evidence for foods containing folate, fish, and selenium and foods containing it is less consistent and no conclusion could be drawn.

SOURCE: World Cancer Research Fund, Continuous Update Project, New Publications on Colorectal Cancer.  Download PDF Reports.

What This Means for Patients

Diet, exercise, and maintaining a healthy weight reduce risk of getting colorectal cancer.  They do not eliminate it.

Even if you follow the WCRF/AICR recommendations for diet and exercise, you still need to:

• Be screened regularly for colorectal cancer.
• Be aware of the symptoms of colorectal cancer and have a colonoscopy to rule out cancer if you have symptoms.

While colorectal is cancer is more common in people over 50, anyone at any age can get colorectal cancer.

He died of colon cancer when he was only 57.

Now the Broadway play LOMBARDI is donating $2 of every ticket sold during March to colon cancer research.

Dan Lauria, who stars as Lombardi in the play, urges people to get screened for colorectal cancer — and stop the disease — in a new public service announcement.

Call 1-866-615-3375 and ask your Representative and Senators to “cosponsor the Colorectal Cancer Prevention, Early Detection, and Treatment Act introduced by Representatives Kay Granger and Jim McGovern and by Senators Joseph Lieberman and Kay Bailey Hutchison”

Thanks to advocates like you, we have already called over 200 Members of Congress.

But, we need to reach more Members if we are going to get this life-saving piece of legislation enacted into law. So please take 5 minutes to call 1-866-615-3375 and ask your legislators to cosponsor the “Colorectal Cancer Prevention, Early Detection, and Treatment Act.”

Don’t know what to say when you call? We have a detailed script you can use.

For additional information, please visit http://link.fightcrc.org/butt-in.

Following up on intriguing hints that aspirin use is related to lower cancer rates, University of Oxford researchers went back to investigate cancer death rates among 25,570 participants in large randomized trials conducted decades ago to test aspirin’s affect on heart disease and stroke. During the trials, which lasted an average of four years, they found about 20 percent fewer cancer deaths in people taking aspirin compared to people taking a placebo.

Drilling down further, the researchers found that nearly half the subjects had been tracked for up to 20 years after the trials ended. After several years in “dusty archives,” the lead researcher Dr. Peter Rothwell told a news conference, they found the outcomes for 12,000 people who had taken either aspirin or placebos in trials decades earlier.

Those taking aspirin had a 64% lower rate of death from esophageal cancer; 58% fewer deaths from stomach cancer; 49% fewer deaths from colorectal cancer; and 32% fewer deaths from lung cancer in nonsmokers.  Significantly they only began to see lower cancer death rates after five years for certain cancers; and it took 10 years to see the lower rates of colorectal cancer deaths.

[Note: These same researchers reported in Lancet last month on death and diagnosis rates specifically of colorectal cancer, using five randomized aspirin trials in Britain, Sweden, and the Netherlands. A 20-year followup found those who had taken aspirin 5 years or longer had about 25% fewer colon cancers (especially proximal cancers which are harder to detect), and a lower rate of rectal cancers; as well as one-third fewer deaths.]

Both the earlier study and the most recently one found no added benefit in taking more than 75 mg, but people in the longest-lasting trials (e.g. more than 7 years) showed the greatest reduction in overall cancer deaths.

These studies are important: They studied long-term outcomes in large numbers of people who’d participated in gold-standard randomized trials. However…the researchers and other experts are quick to caution against people rushing out to buy bottles of baby aspirin. Here are some of the caveats:

• The study’s lead author, Dr. Peter Rothwell, noted that most people in the aspirin-taking group stopped taking aspirin after the studies were finished; and others in the placebo group started taking aspirin. He suggested they might have seen even greater benefits if all subjects had taken aspirin the full 20 years, although others caution that they’d also want to track rates of complications of 20 years of low-dose aspirin.
• All experts warn that aspirin can cause bleeding in the stomach and intestines; and may pose further bleeding risks in elderly people who are particularly prone to falls.
• There was no added benefit in taking more than 75 mg of aspirin a day: In the U.S., “baby aspirin” has 81 mg, and one adult aspirin contains 300 mg (4 times the dose shown beneficial).
• Two-thirds of the British research subjects were men; further research is needed to observe outcomes in women taking low-dose aspirin.Salicylate is aspirin’s active ingredient, but researchers don’t know how it might work against cancer cells. In a test tube, scientists have seen both repair and self-destruction of faulty DNA cells enhanced by aspirin studies. Animal studies show that salicylate can suppress tumor growth.
• The current research will likely stimulate scientists to drill down further, to understand how salicytate affects different types of human cancer cells.

What people need to know:

• The current study is not strong enough by itself to recommend that healthy people at average risk for colorectal cancer should start taking low-dose aspirin, caution many experts.
• Those who are already taking a baby aspirin to decrease their risk for heart disease might be gaining some benefits in avoiding certain types of cancer.
• Because aspirin is a drug with known side effects, people should check with their doctor before starting daily low-dose aspirin.

Sources: Lancet online, 6 December 2010, and Vol 376, Issue 9754 Nov. 20; New York Times, LA Times, and multiple online medical sources.

Nearly 47 million Americans risk their lives — and increase their risk for colorectal cancer — by smoking.

But the good news is that 30 years ago, 1 in 3 people in the US smoked.  Today that has dropped to 1 in 5.

Today, November 18, is a chance to try life without tobacco.  The American Cancer Society hopes that people who stop smoking today will stay smoke-free.

Need help? The National Cancer Institute has tools to help you if you are still struggling with smoking.

Using a computer simulation program, researchers estimated the total lifetime costs for screening and any subsequent treatment of colorectal cancer in people over age 50, using three different kinds of testing (fecal occult blood test, or FOBT; a mix of FOBT and colonoscopy; or colonoscopy alone).

“With rising chemotherapy costs and aging of the population, the Medicare program will face increased costs” in caring for colorectal cancer, said researcher Luuk Goede, MD. His study was aimed at predicting the cost impact of different types of screening in the pre-Medicare population.

The results predicted that total screening costs for the pre-Medicare age group would increase (about 8 percent for FOBT testing; 12.6 percent for the FOBT/colonoscopy program; and almost 14 percent for colonoscopy screening). But if total screening and treatment costs were tracked after the population aged into Medicare, “treatment savings in the older age group fully offset the increased costs in the younger group” for all types of screening, according to Dr. Goede.

What This Means for Patients:

This type of population-based estimate of future costs helps focus public expenditures for screening. But the message for individuals remains the same: Don’t wait until you go on Medicare. Start routine screening for colorectal cancer by age 50 for those with average risk. Legislation in Congress would create a National Colorectal Cancer Screening Program. Urge your Members of Congress to support this lifesaving program.

Source: Medical News Today, Oct 19, 2010

Previously: Colorectal Cancer Screening Before 65 Could Save Medicare Dollars, October 6, 2008

Only one in five primary care doctors in the U.S. follows all the guidelines for colorectal cancer screening, according to a new National Cancer Institute (NCI) study. Of the remaining doctors studied, about 40 percent followed guidelines for some tests; the remaining 40 percent didn’t follow any screening guidelines.

Robin Yabroff, PhD, an NCI epidemiologist, said that the survey of nearly 1,300 primary care physicians showed that many either overuse or underuse screening tests.

Most doctors did recommend initial screening at age 50, and many followed suggested intervals for a specific test. But only 19 percent followed guidelines for every type test.

The guidelines are complicated by the fact that there are four different types of routine screening (fecal or stool tests, colonoscopy, sigmoidoscopy, or barium enema), each with different recommended intervals, and several different organizations have suggested guidelines.

The good news: more people are getting screened. The challenge is for doctors to stay updated with the latest recommendations, and for patients to ask for screening.

What This Means for Individuals

The bottom line: Make a plan with your doctor.

• Routine screening guidelines only apply if you have no symptoms or risk factors. If you have a family history of colon or rectal cancer, or a history of ulcerative colitis or Crohn’s disease, you will likely need more frequent screening, or to start before age 50.
• Because they detect cancer but not precancerous lesions, annual fecal (stool) tests must be done faithfully every year. For colonoscopy, you must do careful pre-test preparation for the most accurate results.
• Don’t wait until the next scheduled screening if you develop symptoms (e.g., changed bowel habits or stools, unexplained abdominal symptoms, fatigue, rectal bleeding or dark stools).
• Read about the current guideline recommendations or call the Colorectal Cancer Coalition Answer Line at 877-4CRC-111.

SOURCE: Online edition of the Journal of General Internal Medicine, Oct. 14, 2010