Colorectal cancer – prevention and screening
Abstract
Background: Colorectal cancer is the second most common cause of cancer death in Slovenija and its incidence in the last decades is rising. According to the epidemiological data from 2001, the incidence in male is 64/100,000 in female 48/100,000. Even though the relative fiveyear survival of the patients with this disease is rising, the majority of them are discovered in the advanced stage of the disease with poor prognosis.
Conclusions: If diagnosed and surgically removed in its early stage, colorectal cancer is a curable disease. Using screening tests, such as fecal occult blood test and endoscopy of the lower gastrointestinal tract, we can detect and treat premalignant lesions and early stages of colorectal cancer. In Slovenia, colorectal cancer could be the third malignant disease, after uterine cervix and breast cancer where secondary prevention should be introduced in order to reduce its incidence and mortality. In the following article the authors present and discuss the results of studies made on the prevention of colorectal cancer and the most commonly used screening methods, as well as some of the methods that are still being evaluated. They suggest measures that should be taken in Slovenia against this disease.
Downloads
References
Incidenca raka v Sloveniji 2001. Ljubljana: Onkološki inštitut, Register raka za Slovenijo; 2004.
Incidenca raka v Sloveniji 2000. Ljubljana: Onkološki inštitut, Register raka za Slovenijo; 2003.
Pompe-Kirn V, Zakotnik B, Volk N, Benulič T, Škrk J. Preživetje bolnikov z rakom v Sloveniji 1963–1990. Ljubljana: Onkološki inštitut; 1995.
Pisani P, Parkin DM, Bray F, Ferlay J. Estimates of the worldwide mortality from twenty-five cancers in 1990. Int J Cancer 1999; 83: 18–29.
Coleman MP, Gatta G, Verdecchia A, Estève J, Sant M, Storm H, et al. Eurocare-3 summary: cancer survival in Europe at the end of the 20th century. Ann of Oncol 2003; 14 Suppl 5: 128–49.
Rhodes JM. Colorectal cancer screening in the UK: Joint Position Statement by the British Society of Gastroenterology, the Royal College of Physicians, and the Association of Coloproctology of Great Britain and Ireland. Gut 2000; 46: 746–8.
Markovič S, Repše S, Heijnen S. Obvladovanje kolorektalnega karcinoma. Nacionalna klinična smernica. Projekt razvoja sistema upravljanja zdravstvenega varstva. Ljubljana: Ministrstvo za zdravje; 2002.
Pompe-Kirn V. Epidemiološke značilnosti raka širokega črevesa in danke v Sloveniji. In: Repše S. Kirurgija širokega črevesa in danke. Zbornik simpozija. Ljubljana: Klinični center, Kirurške klinike, Kirurška šola; 1996. p. 79–85.
Gadžijev EM, Markovič S, Orel J, Pegan V, Repše S, Štabuc B, et al. Priporočila za celostno obravnavo bolnikov z rakom prebavil. Ljubljana: Ministrstvo za zdravje R Slovenije; 1997.
Ferlay J, Bray F, Sankila R, Parkin MD. Eucan 1998: Cancer incidence, mortality and prevalence in European Union 1998. Lyon: International Agency for Research on Cancer, IARC press; 1999. Dosegljivo na: http://www-dep.iarc.fr/eucan/eucan.htm
Crespi M, Stigliano V, Assisi D. Current trends in screening and secondary prevention of colorectal cancer. Hepatogastroenterology 2001; 48: 1635–40.
Hawk ET, Limburg PJ, Viner JL. Epidemiology and prevention of colorectal cancer. In: Guillem JG, Sigurdson ER. Colorectal cancer. Surg Clin N Am 2002; 82: 905–42.
Sandhu MS, White IR, McPherson K. Systematic review of the prospective cohort studies on meat consumption and colorectal cancer risk: A meta-analytical approach. Cancer Epidemiol Biomarkers Prev 2001; 10: 439–46.
Bergström A, Pisani P, Tenet P, Wolk A, Adamo HO. Overweight as an avoidable cause of cancer in Europe. Int J Cancer 2001; 91: 421–30.
Kim YI. AGA technical review: Impact of dietary fiber on colon cancer occurence. Gastroenterology 2000; 118: 1235–57.
Michels KB, Giovannucci E, Joshipura KJ, Rosner B. Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst 2000; 92: 1740–52.
Terry P, Giovannucci E, Michels KB, Bergkvist L, Hansen H, Holmberg L, et al. Fruit, vegetables, dietary fiber, and risk of colorectal cancer. J Natl Cancer Inst 2001; 93: 525–33.
Alberts DS, Martínez ME, Roe DJ, Guillén-Rodríguez JM, Marshall JR, Leeuwen van JB, et al. Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. N Eng J Med 2000; 342: 1156–62.
Schatzkin A, Lanza E, Corle D, Lance P, Iber F, Caan B, et al. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. N Eng J Med 2000; 342: 1149–55.
Byers T. Diet, colorectal adenomas, and colorectal cancer. N Eng J Med 2000; 342: 1206–7.
Reddy BS. Novel approaches to the prevention of colon cancer by nutritional manipulation and chemoprevention. Cancer Epidemiol Biomarkers Prev 2000; 9: 239–47.¸
Giovannucci E, Rimm EB, Ascherio A. Alcohol, low-methionine, low-folates diets, and risk of colon cancer in men. J Natl Inst 1995; 87: 265–73.
Stampfer MJ, Fuchs CS, Colditz GA, Speizer FE, Willett WC. An updated review of the epidemiological evidence that cigarette smoking increases risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev 2001; 10: 725–31.
Colditz GA, Cannuscio CC, Frazier AL. Physical activity and reduced risk of colon cancer: implications for prevention. Cancer Causes and Control 1997; 8: 649–67.
Friedenreich CM. Physical activity and cancer prevention: From observational to intervention research. Cancer Epidemiol Biomarkers Prev 2001; 10: 287–301.
Sandler RS, Halabi S, Baron JA, Budinger S, Paskett E, Keresztes R, et al. A randomized trial of Aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. N Eng J Med 2003; 348: 883–90.
Baron JA, Cole FB, Sandler RS, Halile RW, Ahnen D, Bresalier R, et al. A randomized trial of Aspirin to prevent colorectal adenomas. N Eng J Med 2003; 348: 891–9.
Benamouzig R, Deyra J, Martin A, Girard B, Jullian E, Piednoir B, et al. Daily soluble Aspirin and prevention of colorectal adenoma recurrence: one year results of the APACC trial. Gastroenterology 2003; 125: 328–36.
Giardielo FM, Hamilton SR, Krush AJ, Piantadosi S, Hylind LM, Celano P, et al. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis. N Eng J Med 1993; 328: 1313–6.
Steinbach G, Lynch PM, Phillips RKS, Wallace MH, Hawk E, Gordon GB, et al. The effect of celecoxib, a cyclooxygenase – 2 inhibitor, in familial adenomatous polyposis. N Eng J Med 2000; 342: 1946–52.
Imperiale TF. Aspirin and the prevention of colorectal cancer. N Eng J Med 2003; 348: 879–80.
Ferkolj I, Markovič S. Kolorektalni karcinom. In: Kocijančič A, Mrevlje F. Interna medicina. 2nd ed. Ljubljana: EWO in DZS; 1998. p. 409–13.
Levin B, Brooks D, Smith RA, Stone A. Emerging technologies in screening for colorectal cancer: CT colonography, immunochemical fecal occult blood tests, and stool screening using molecular markers. CA Cancer J Clin 2003; 53: 44–55.
Trowbridge B, Burt RW. Colorectal cancer screening. In: Guillem JG, Sigurdson ER. Colorectal cancer. Surg Clin N Am 2002; 82: 943–58.
Simon JB, Fletcher RH. Should all people over the age 50 have regular fecal occult – blood tests? N Eng J Med 1998; 338: 1151–5.
Mandel JS, Bond JH, Church TR, Snover DC, Bradley M, Schuman LM, et al. Reducing mortality for colorectal cancer by screening for fecal occult blood. N Eng J Med 1993; 328: 1365–71.
Hardcastle JD, Chamberlain JO, Robinson MHE, Moss SM, Amar SS, Balfour TW, et al. Randomised controlled trial of faecaloccult-blood screening for colorectal cancer. Lancet 1996; 348: 1472–7.
Kronborg O, Fenger C, Olsen J, Jørgensen OD, Søndergaard O. Randomised study of screening for colorectal cancer with faecal – occult blood test. Lancet 1996; 348: 1467–71.
Mandel MS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Eng J Med 2000; 343: 1603–7.
Lieberman DA, Weiss DG. One time screening for colorectal cancer with combined fecal-occult blood testing and examination of distal colon. N Eng J Med 2001; 345: 555–60.
Mlinarič V. Rak širokega črevesa in danke, endoskopska diagnostika in zdravljenje. In: Repše S. Kirurgija širokega črevesa in danke: zbornik simpozija. Ljubljana: Klinični center, Kirurške klinike, Kirurška šola; 1996. p.103–13.
Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopy polypectomy. N Eng J Med 1993; 27: 1977–81.
Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Eng J Med 2000; 343: 162–8.
Smith RA, Cokkinides V, Eyre HJ. American Cancer Society Guidelines for the early detection of cancer, 2004. CA Cancer J Clin 2004; 54: 41–52.
Skok P. Rak debelega črevesa. Zbornik predavanj o kolorektalnem karcinomu. Zveza invalidskih društev Slovenije. ILCO; 2003 Oct 17; Maribor, Slovenija.
Lešničar H, Pompe-Kirn V, Zakotnik B, Čufer T, Repše S, PrimicŽakelj M, et al. Preživetje bolnikov z rakom. Je po evropskih kazalcih Slovenija res padla na izpitu iz onkologije? Poročilo posveta o preživetju bolnikov z rakom v Sloveniji. Onkologija 2003; 7(2): 63–76.
McGregor SE, Hilsden RJ, Murray A, Bryant HE. Colorectal cancer screening: practices and opinions of primary care physicians. Prev Med 2004; 39: 279–85.
Dajčman D. Prvi kongres slovenskega združenja za gastroenterologijo in hepatologijo. Isis 2005; 14(1): 104–6.
Statistični urad RS: Statistični letopis za leto 2003. Podatki o številu prebivalcev RS z dne 31. 12. 2003 po starosti in spolu. Dosegljivo na: http://www.stat.si/letopis/index_vsebina.asp
Deutsche Gesellschaft für Verdauungs und Stoffwechselkrankheiten. Sektion Endoskopie. Richtlinien und Empfelungen. Dosegljivo na: http://www.dgvs.de/Leitlinien/3.1.Kolorektales Karzinom.pdf
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
