The Colon

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Colon/Rectal Cancer
Color Cancer Campaign

Colon/Rectal Cancer

Colorectal cancer is the second leading cause of cancer-related deaths in the United States (1). In 2000, approximately 130,000 cases of the disease will be diagnosed, and more than 56,000 deaths will be attributed to this cancer (1). Randomized controlled trials show that screening by fecal occult blood testing can decrease the death rate of this disease by as much as 30%, and prospective observational data suggest that endoscopic removal of premalignant polyps can decrease the incidence 75% to 90% (2,3). Because screening is effective in reducing morbidity and mortality from colorectal cancer, a number of professional societies, government agencies, and voluntary health organizations recommend screening for colorectal cancer for persons over 50 (4). Despite recommendations for screening, research indicates that many who are at risk for colorectal cancer are not being screened (5). Men's Health Network, or


1. American Cancer Society. Cancer facts and figures, 2000. Atlanta, Georgia: American Cancer Society, 2000; publication no. 5008.00.

2. Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood: Minnesota Colon Cancer Control Study. N Engl J Med 1993;328:1365--71.

3. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy: The National Polyp Study Workgroup. N Engl J Med 1993;329:1977--81.

4. Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997;112:594--642.

5. CDC. Screening for colorectal cancer---United States, 1997. MMWR 1999;48:116--21.


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Fiber Not Protective for Colon Cancer

There are plenty of good reasons to eat a fiber-rich diet, but lowering colorectal cancer risk may not be among them. A newly published pooled analysis of 13 studies involving more than 725,000 people found little evidence of a protective benefit for dietary fiber against colon cancer. Compared with people who ate low-fiber diets, fiber eaters were more likely to take multivitamins and eat foods rich in the B-vitamin folate, and they ate less red meat. It is possible that studies showing a protective benefit against colon cancer may not have fully adjusted for other healthy lifestyle choices that could play a role in risk.

Colorectal Cancer Treatment Takes a Turn

The approval of this new drug may mark a new approach to treating colorectal cancer. See what the FDA has to say.

A Potential Colon Cancer Culprit Found

A diet causing sudden jumps in blood sugar could also boost your risk for colon cancer. See which foods are to blame.

Still Squeamish About Screenings?

It's the second leading cause of cancer death in the U.S., yet less than 50% of Americans over the age of 50 get tested for it. Find out what disease it is, then then learn about the new testing method that could make the screening process a lot more comfortable.

Aspirin May Lower Colon Cancer Risk

People who take aspirin to protect their hearts may also be protecting themselves against one of the leading causes of cancer death. Two new studies suggest that an aspirin a day may help prevent the formation of polyps that can lead to colon cancer.

Researchers found that a daily aspirin significantly reduced the recurrence of colon polyps among people with previous colon cancers. A weaker association was seen for patients with a history of polyps but no cancer. But it is too soon to recommend that anyone -- even those at high risk -- take aspirin or any other anti-inflammatory drug solely to lower their colon cancer risk, the researchers say.

The studies appear in the March 6, 2003 issue of The New England Journal of Medicine.

"Screening is still the most important thing that people can do to protect themselves against colorectal cancer," lead researcher Robert S. Sandler, MD, tells WebMD. "The worst thing that could happen is for people to get the idea that they don't have to get screened if they take aspirin. But these studies do suggest that aspirin helps prevent the development of colon polyps."

Each year, roughly 57,000 Americans die of colon cancer, making it the second leading cause of cancer deaths overall. The risk of developing colon cancer and the polyps that can lead to the disease increases with age. Nine out of 10 people diagnosed with colon cancer are over the age of 50.

Previous trials attempting to show a protective benefit for dietary fiber, antioxidant vitamins, and diet have proved disappointing. There is some evidence that dietary calcium protects against the formation of polyps, but the findings are not conclusive.

Animal trials and preliminary studies in humans have suggested that regular aspirin use lowers the risk of colon cancer. To further test this theory, Sandler and colleagues recruited more than 1,100 patients with a history of polyps and 635 patients with a history of colon cancer.

The colon cancer patients were treated with a regular, coated aspirin (325 mg) or placebo daily. The trial was stopped early, after roughly 31 months, because the aspirin group had significantly fewer polyps.

The study group with a history of polyps but not cancer received daily doses of low-dose aspirin (81 mg), a regular aspirin, or placebo for an average of just under three years. The patients in the two aspirin groups had a lower rate of polyp recurrence than those in the placebo group. But, inexplicably, the patients given low-dose aspirin had better responses than patients taking the higher dose of aspirin every day.

Although other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, were not tested, there is good reason to believe that they also help prevent precancerous polyps from forming. A large study is now under way assessing whether one of the newest class of NSAIDs, Cox-2 inhibitors, helps prevent colon cancer. Cox-2 inhibitors include Bextra, Celebrex, and Vioxx. The hope is that these drugs will work as well or better than aspirin but with fewer side effects. Regular use of aspirin and many other NSAIDs is associated with an increased risk for stomach or intestinal bleeding.

In an editorial accompanying the two studies, Indiana University School of Medicine Professor Thomas F. Imperiale, MD, writes that it is unlikely there will be a definitive clinical trial of aspirin or other NSAIDs for the prevention of colon cancer. He agrees that although aspirin and other NSAIDs may have a modest impact on colon cancer risk, the evidence is not strong enough to recommend their routine use for preventing the cancer.

"The bottom line is that these trials are a step in the right direction, but we have not reached the threshold where we can change clinical practice," he tells WebMD. "This suggests that people already on aspirin therapy may derive an additional benefit. But the best prevention for colorectal cancer is still regular screening once you hit the age of 50."
Source: Salynn Boyles, The New England Journal of Medicine, March 6, 2003. Robert S. Sandler, MD, MPH, professor of medicine and epidemiology, University of North Carolina, Chapel Hill. Thomas F. Imperiale, MD, professor of medicine, Indiana University School of Medicine.

National Colorectal Cancer Awareness Month - March

U.S. Senate declared March 2000 as the first National Colorectal Cancer Awareness Month. The purpose of this designation is to increase public awareness about the disease burden associated with colorectal cancer and to encourage people over 50 to reduce their risk for colorectal cancer through regular screening examinations. Additional information about the month, special events, and resource materials are available at * Information on CDC's national colorectal cancer action campaign Screen for Life is available at

Senate Panel OKs Colon Cancer Bill

Health insurers would be required to cover regular colon cancer screenings for people who are over 50 or are at high risk for the disease under a bill approved by a Senate committee.

Many Avoid Colon Cancer Tests: They're too embarrassed to get tested

Would you be too embarrassed to take a simple test that could save your life? Many people are when it comes to colon cancer. A recent British study described by Avanova indicates that nearly half of the population would feel uncomfortable discussing potential symptoms, such as changes in bowel habits, with their family doctor. Avoiding an embarrassing discussion or examination can cost someone a life if colon cancer goes undetected until it has spread. And the risk of dying from colon cancer is not insignificant. Most people are surprised to learn that colon cancer ranks as the second-leading cause of cancer deaths in the United States and the United Kingdom, and the third-leading cause of cancer deaths in Canada. Even a single screening for colon cancer can save lives. An evaluation of 22 screening methods found that a single colonoscopy at age 55 would spot enough cancers early to lower colon cancer deaths 30 percent, according to a wire service story in the Philadelphia Inquirer.

Mutations In Gene For Rare Disease Associated With Risk Of Colon Cancer

Mutations in the hereditary hemochromatosis gene (HFE) are associated with an increased risk of colon cancer, according to a study in the January 15, 2003 issue of the Journal of the National Cancer Institute.
Source: Journal of the National Cancer Institute,

Aspirin Lowers Colon Cancer Risk

A daily baby aspirin modestly reduces the risk of colon cancer by preventing the growth of ominous polyps, according to a major study released Sunday.

Trace Proteins in Stool May Point to Colon Cancer

Traces of a specific protein found in stool may be used to detect cancer in the left, or distal, colon, conclude Nicolas Coleman and colleagues from the Medical Research Council's Cancer Cell Unit, Cambridge, U.K., in the June 1 issue of The Lancet.

Current tests for colorectal cancer include colonoscopy, flexible sigmoidoscopy, and a test for traces of blood in the stool. A past study found that cancer cells sloughed off into stool could be easily detected using a DNA test. This study suggests that a simple protein test could also serve his purpose.

Coleman and his colleagues looked for minichromosome maintenance protein 2 (MCM2) expression in 40 people with symptomatic colorectal cancer and 25 people without colon cancer. The authors found the protein in 37 of the 40 people with colon cancer. In contrast, the authors did not find the protein in the control group. The authors note that the three stool samples that did not turn up MCM2 were from patients with right, or proximal, colon cancer.

Because this study was conducted in an experimental setting, these findings might have differed in a population with a higher frequency of proximal colon cancers, the authors say. However, they maintain that their approach "might ultimately prove suitable for population screening, either alone or in combination with other tests."

The complete study (Davies J. et al. Lancet 2002;359:1917-9) is available from The Lancet at

For JNCI News articles on the stool test, see "Stool Test Identifies Markers for Colorectal Cancer, Studies Show" and "Studies Move Closer to Genetic Test to Detect Colon Cancer".

Doctors Not Giving Colorectal Cancer Screening Test Survey Finds

Colorectal cancer is 90 percent curable when detected early. Yet respondents to a new survey said only 51 percent of their doctors discussed colon cancer screening with them, and of those, 56 percent failed to use a simple Fecal Occult Blood Test. Survey results are available at

Several recent studies prove that annual use of a FOBT could prevent 33,000 deaths from colorectal cancer a year. The American Cancer Society recommends that adults over 50 use the test annually to identify hidden blood in the stool -- one of the early warning signs of colorectal cancer.

The quick and pain-free FOBT can often indicate if more invasive screening procedures are necessary. Most colon cancers develop from pre-cancerous polyps, which can actually be removed during colonoscopy screening. EZ Detect FOBTs, manufactured by Biomerica Inc. of Newport Beach, CA (NASDAQ:BMRA) are being given away free as a public service during National Colorectal Cancer Awareness Month, March 2000. Product and survey results can be found at *326 respondents as of March 22, 2000. It was requested that respondents be over 50. Contact B.L. Ochman, 212.385.2200 or or Jennifer Irani: Biomerica Corp., 800.854.3002 x 315 or

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Colorectal cancer is 90 percent curable when detected early.

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